Lee Min Woo, Choi Byoung Geol, Kim Suhng Wook, Rha Seung-Woon, Shim Min Suk, Kim Dae Jin, Seo Hong Seog, Oh Dong Joo, Jeong Myung Ho
Department of Integrated Biomedical and Life Sciences, Korea University Graduate School, Seoul, Korea.
Department of Medicine, Korea University Graduate School, Seoul, Korea.
Clin Exp Pharmacol Physiol. 2017 Jun;44(6):631-638. doi: 10.1111/1440-1681.12755.
Ambient air pollution is well-known to be a serious risk factor for cardiovascular diseases, stroke, and death. However, the association between air pollutants (AP) exposure and short-term clinical outcomes in acute myocardial infarction (AMI) patients (pts) has not been elucidated well. In the present study, 37 880 AMI pts were enrolled from October 2005 to December 2013 in a nationwide large-scale, prospective, multicentre Korea AMI registry (KAMIR registry; http://www.kamir.or.kr). We obtained data on AP (e.g., NO , SO , CO, O and PM ) from the Korean National Institute of Environmental Research (NIER; http://www.nier.go.kr). Clinical endpoints included death, recurrent myocardial infarction (Re-MI), any revascularization and composite of all-cause death and Re-MI. Exposure to AP is defined as the average exposure to AP within 24 hours before AMI admission. We observed that a 0.01 part per million (ppm) increase in NO concentration, 0.001 ppm increase in SO concentration, and 0.1 ppm increase in CO concentration each increased the risk of total death by 9.7% (95% CI, 6.2%-13.4%), 1.9% (95% CI, 0.3%-3.6%), and 2.1% (95% CI, 0.5%-3.9%), respectively. Exceptionally, O decreased the risk of total death by 0.6% (95% CI -0.2% to -1.0%) per 0.01 ppm increase. PM was not related to any cardiovascular events. AP were each stratified into five quintiles according to ranges of AP levels. After adjusting analysis for risk variables, only high quintiles (Q4, Q5) of NO were positively associated with total death, cardiac death and MI, while SO , CO, O and PM were shown to be not related to any cardiovascular events at all levels. In AMI patients, each AP and its concentration has shown a different effect to short-term mortality and cardiovascular events.
众所周知，环境空气污染是心血管疾病、中风和死亡的严重风险因素。然而，空气污染物（AP）暴露与急性心肌梗死（AMI）患者短期临床结局之间的关联尚未得到充分阐明。在本研究中，2005年10月至2013年12月期间，在全国范围内大规模、前瞻性、多中心的韩国急性心肌梗死注册研究（KAMIR注册研究；http://www.kamir.or.kr）中纳入了37880例AMI患者。我们从韩国国家环境研究所（NIER；http://www.nier.go.kr）获取了有关AP（如NO、SO、CO、O和PM）的数据。临床终点包括死亡、再发性心肌梗死（Re-MI）、任何血管重建以及全因死亡和Re-MI的复合终点。AP暴露定义为AMI入院前24小时内AP的平均暴露量。我们观察到，NO浓度每增加0.01百万分之一（ppm）、SO浓度每增加0.001 ppm以及CO浓度每增加0.1 ppm，全因死亡风险分别增加9.7%（95%CI，6.2%-13.4%）、1.9%（95%CI，0.3%-3.6%）和2.1%（95%CI，0.5%-3.9%）。例外的是，O每增加0.01 ppm，全因死亡风险降低0.6%（95%CI -0.2%至-1.0%）。PM与任何心血管事件均无关联。根据AP水平范围，将每种AP分为五个五分位数。在对风险变量进行校正分析后，仅NO的高五分位数（Q4、Q5）与全因死亡、心源性死亡和心肌梗死呈正相关，而SO、CO、O和PM在所有水平上均与任何心血管事件无关。在AMI患者中，每种AP及其浓度对短期死亡率和心血管事件均显示出不同的影响。
