The Role of Environmental PM in Admission Acute Heart Failure in ST-Elevation Myocardial Infarction patients - An Observational Retrospective Study.

BACKGROUND

Air pollution with increased concentrations of fine (<2.5 μm) particulate matter (PM) increases the risk of cardiovascular morbidity and mortality. Even short-term increase of PM may help trigger ST-elevation myocardial infarction (STEMI) and heart failure (HF) in susceptible individuals, even in areas with good air quality.

PURPOSE

To evaluate the role of PM levels ≥20 µg/m in admission acute HF in STEMI patients.

MATERIALS AND METHODS

In 290 STEMI patients with the leading reperfusion strategy primary percutaneous coronary intervention (PPCI), we retrospectively studied independent predictors of admission acute HF and included admission demographic and clinical data as well as ambient PM levels ≥20 µg/m. We defined admission acute HF in STEMI patients as classes II-IV by Killip Kimball classification.

RESULTS

Acute admission HF was observed in 34.5% of STEMI patients. PPCI was performed in 87.1% of acute admission HF patients and in 94.7% non-HF patients (p= 0.037). Significant independent predictors of acute admission HF were prior diabetes (OR 2.440, 95% CI 1.100 to 5.400, p=0.028), admission LBBB (OR 10.190, 95% CI 1.160 to 89.360, p=0.036), prior resuscitation (OR 2.530, 95% CI 1.010 to 6.340, p=0.048), admission troponin I≥5µg/l (OR 3.390, 95% CI 1.740 to 6.620, p<0.001), admission eGFR levels (0.61, 95% CI 0.52 to 0.72, p < 0.001), and levels of PM ≥20 µg/m (OR 2.140, 95% CI 1.005 to 4.560, p=0.049) one day before admission.

CONCLUSION

Temporary short-term increase in PM levels (≥20 µg/m) one day prior to admission in an area with mainly good air quality was among significant independent predictors of acute admission HF in STEMI patients.