Department of Invasive Cardiology, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276, Białystok, Poland.
Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 45/47 Ziolowa St., 40-635, Katowice, Poland.
Environ Res. 2021 Jun;197:111154. doi: 10.1016/j.envres.2021.111154. Epub 2021 Apr 17.
There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas.
A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas.
The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS.
A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM, PM, NO, SO, CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m of NO concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009-1.257; P = 0.034, lag-0) and an increase of 1 mg/m in CO concentration (RR = 1.055, 95%CI = 1.010-1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m in NO (OR = 1.062, 95%CI = 1.020-1.094; P = 0.005, lag-0), SO (OR = 1.061, 95%CI = 1.010-1.116; P = 0.018, lag-4), PM (OR = 1.010, 95%CI = 1.001-1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m in SO (OR = 1.094, 95%CI = 1.030-1.162; P = 0.002, lag-1), PM (OR = 1.041, 95%CI = 1.020-1.073; P < 0.001, lag-1), PM (OR = 1.030, 95%CI = 1.010-1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area.
The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI.
目前缺乏直接比较工业和非工业地区空气污染对急性冠状动脉综合征（ACS）发生影响的研究。
比较两个工业不同地区空气污染暴露与 ACS 发病的关系。
该研究覆盖了 2008 年至 2017 年的 600 万人群随访年和 5 种污染物。采用 7 滞后时间序列回归分析评估空气污染对 ACS 的影响。
共纳入 9046 例 ACS 患者，其中 ST 段抬高型心肌梗死（STEMI）患者 3895 例（43.06%），其中非工业地区 45.39%，工业地区 42.37%；非 ST 段抬高型心肌梗死（NSTEMI）患者 5151 例（56.94%），其中非工业地区 54.61%，工业地区 57.63%。工业地区 PM、PM、NO、SO、CO 的日浓度均高于非工业地区（P<0.001）。在非工业地区，NO 浓度增加 10μg/m（比值比（OR）=1.126，95%置信区间（CI）=1.009-1.257；P=0.034，滞后 0）和 CO 浓度增加 1mg/m（RR=1.055，95%CI=1.010-1.103；P=0.017，滞后 0）与 NSTEMI 住院人数增加相关（工业地区 NO 浓度增加 10μg/m（OR=1.062，95%CI=1.020-1.094；P=0.005，滞后 0），SO（OR=1.061，95%CI=1.010-1.116；P=0.018，滞后 4），PM（OR=1.010，95%CI=1.001-1.030；P=0.047，滞后 6））。在工业地区 STEMI 患者中，发现住院人数增加与 SO（OR=1.094，95%CI=1.030-1.162；P=0.002，滞后 1），PM（OR=1.041，95%CI=1.020-1.073；P<0.001，滞后 1），PM（OR=1.030，95%CI=1.010-1.051；P<0.001，滞后 1）浓度增加相关。非工业地区空气污染与 STEMI 住院人数无关。
工业地区 ACS 与空气污染相关的风险高于非工业地区。NO 对 NSTEMI 的发病影响在两个地区均观察到。在工业地区，PMs 和 SO 对 NSTEMI 和 STEMI 的影响也观察到。NSTEMI 患者的临床效应时间延迟更明显，尤其是在暴露于 PM 后。慢性暴露于空气污染可能是颗粒物空气污染对 STEMI 发病率的短期影响差异的基础。
