Sadeghi Mehraban, Ahmadi Ali, Baradaran Azar, Masoudipoor Neda, Frouzandeh Soleiman
Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Department of Epidemiology and Biostatistics, School of Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
J Res Med Sci. 2015 Aug;20(8):757-62. doi: 10.4103/1735-1995.168382.
This study aimed to determine the relationship between the environmental factor, clinical risk factors, and individual variables with mortality due to acute myocardial infarction (MI) in Isfahan.
This cross-sectional study was performed between April 2012 and March 2013. The data on the patients' mortality due to MI in Isfahan were obtained from the MI National Registry. The international classification system (ICD10: I21-I22) was used to diagnose MI. The air quality indicators and environmental variables were used to measure the air pollution. Multilevel logistic regression in the Stata software was used to determine the factors associated with mortality in patients and odds ratios (ORs) were calculated.
Six hundred eleven patients with MI were studied during 1-year. 444 (72.2%) patients were male and the rest were female. 4.7% of the patients died due to MI. The mean age at MI incidence was 62.2 ± 13 years. Of the air pollution parameters, PM10 had the maximum mean concentration (49.113 ppm), followed by NOX, NO, NO2, CO, SO2, and O3. The adjusted OR of mortality was derived 2.07 (95% CI: 1.5-2.85) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.84 (95% CI: 1.13-3) for age, 1.06 (95% CI: 1.01-1.20) for CO, 1.1 (95% CI: 1.03-1.30) for O3, and 1.04 (95% CI: 1.01-1.4) for SO2, all of which were considered as the risk factors of mortality. However, OR of mortality was 0.79 for precipitation (95% CI: 0.74-0.84) and 0.52 for angioplasty (95% CI: 0.4-0.68) were considered as protective factors of mortality. The individual characteristics including age, history of MI in the immediate family, hypertension, and diabetes were significantly associated with mortality from MI. The indices of air pollution including SO2, CO, O3, and environmental factors such as the precipitation and temperature were the determinants of mortality in patients with MI.
With regards to the factors associated with mortality from MI reported in this study, air pollution and environmental factors, in addition to the risk factors and predictive factors, should be particularly addressed to control the mortality from MI.
本研究旨在确定伊斯法罕地区环境因素、临床风险因素及个体变量与急性心肌梗死（MI）所致死亡之间的关系。
本横断面研究于2012年4月至2013年3月进行。伊斯法罕地区MI患者的死亡数据来自MI国家登记处。采用国际分类系统（ICD10：I21 - I22）诊断MI。空气质量指标和环境变量用于测量空气污染。使用Stata软件进行多水平逻辑回归分析以确定与患者死亡相关的因素，并计算比值比（OR）。
1年期间共研究了611例MI患者。444例（72.2%）为男性，其余为女性。4.7%的患者死于MI。MI发病时的平均年龄为62.2±13岁。在空气污染参数中，PM10的平均浓度最高（49.113 ppm），其次是NOX、NO、NO2、CO、SO2和O3。右束支传导阻滞的校正OR为2.07（95%CI：1.5 - 2.85），ST段抬高型MI为1.5（95%CI：1.3 - 1.7），年龄为1.84（95%CI：1.13 - 3），CO为1.06（95%CI：1.01 - 1.20），O3为1.1（95%CI：1.03 - 1.30），SO2为1.04（95%CI：1.01 - 1.4），所有这些均被视为死亡风险因素。然而，降水的OR为0.79（95%CI：0.74 - 0.84），血管成形术的OR为0.52（95%CI：0.4 - 0.68），被视为死亡保护因素。个体特征包括年龄、直系亲属的MI病史、高血压和糖尿病与MI死亡显著相关。空气污染指标如SO2、CO、O3以及环境因素如降水和温度是MI患者死亡的决定因素。
鉴于本研究报告的与MI死亡相关的因素，除了风险因素和预测因素外，空气污染和环境因素应特别加以关注，以控制MI死亡率。
