短期暴露于细颗粒物空气污染优先与ST段抬高型急性冠脉事件风险相关。
Short-Term Exposure to Fine Particulate Matter Air Pollution Is Preferentially Associated With the Risk of ST-Segment Elevation Acute Coronary Events.
作者信息
Pope C Arden, Muhlestein Joseph B, Anderson Jeffrey L, Cannon John B, Hales Nicholas M, Meredith Kent G, Le Viet, Horne Benjamin D
机构信息
Department of Economics, Brigham Young University, Provo, UT (A.P., J.B.C., N.M.H.).
Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.B.M., J.L.A., K.G.M., V.L., B.D.H.) Department of Internal Medicine, University of Utah, Salt Lake City, UT (J.B.M., J.L.A., B.D.H.).
出版信息
J Am Heart Assoc. 2015 Dec 8;4(12):e002506. doi: 10.1161/JAHA.115.002506.
BACKGROUND
Air pollution is associated with greater cardiovascular event risk, but the types of events and specific persons at risk remain unknown. This analysis evaluates effects of short-term exposure to fine particulate matter air pollution with risk of acute coronary syndrome events, including ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, unstable angina, and non-ST-segment elevation acute coronary syndrome.
METHODS AND RESULTS
Acute coronary syndrome events treated at Intermountain Healthcare hospitals in urban areas of Utah's Wasatch Front were collected between September 1993 and May 2014 (N=16 314). A time-stratified case-crossover design was performed matching fine particulate matter air pollution exposure at the time of each event with referent periods when the event did not occur. Patients served as their own controls, and odds ratios were estimated using nonthreshold and threshold conditional logistic regression models. In patients with angiographic coronary artery disease, odds ratios for a 10-μg/m(3) increase in concurrent-day fine particulate matter air pollution >25 μg/m³ were 1.06 (95% CI 1.02-1.11) for all acute coronary syndrome, 1.15 (95% CI 1.03-1.29) for ST-segment elevation myocardial infarction, 1.02 (95% CI 0.97-1.08) for non-ST-segment elevation myocardial infarction, 1.09 (95% CI 1.02-1.17) for unstable angina, and 1.05 (95% CI 1.00-1.10) for non-ST-segment elevation acute coronary syndrome events. Excess risk from fine particulate matter air pollution exposure was not observed in patients without angiographic coronary artery disease.
CONCLUSIONS
Elevated fine particulate matter air pollution exposures contribute to triggering acute coronary events, especially ST-segment elevation myocardial infarction, in those with existing seriously diseased coronary arteries but not in those with nondiseased coronary arteries.
背景
空气污染与更高的心血管事件风险相关，但事件类型和特定的风险人群仍不明确。本分析评估短期暴露于细颗粒物空气污染与急性冠脉综合征事件风险之间的关系，这些事件包括ST段抬高型心肌梗死、非ST段抬高型心肌梗死、不稳定型心绞痛以及非ST段抬高型急性冠脉综合征。
方法与结果
收集了1993年9月至2014年5月期间在犹他州瓦萨奇山前城市地区山间医疗保健医院接受治疗的急性冠脉综合征事件（N = 16314）。采用时间分层病例交叉设计，将每次事件发生时的细颗粒物空气污染暴露情况与事件未发生时的对照期进行匹配。患者自身作为对照，使用非阈值和阈值条件逻辑回归模型估计比值比。在有冠状动脉造影显示冠心病的患者中，当日细颗粒物空气污染浓度>25 μg/m³且每增加10 μg/m³时，所有急性冠脉综合征的比值比为1.06（95%可信区间1.02 - 1.11），ST段抬高型心肌梗死为1.15（95%可信区间1.03 - 1.29），非ST段抬高型心肌梗死为1.02（95%可信区间0.97 - 1.08），不稳定型心绞痛为1.09（95%可信区间1.02 - 1.17），非ST段抬高型急性冠脉综合征事件为1.05（95%可信区间1.00 - 1.10）。在无冠状动脉造影显示冠心病的患者中未观察到细颗粒物空气污染暴露带来的额外风险。
结论
暴露于升高的细颗粒物空气污染会促使已有严重病变冠状动脉的患者引发急性冠脉事件，尤其是ST段抬高型心肌梗死，而对于冠状动脉无病变的患者则无此影响。
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