Urbanowicz Tomasz, Skotak Krzysztof, Olasińska-Wiśniewska Anna, Filipiak Krzysztof J, Płachta-Krasińska Aleksandra, Piecek Jakub, Krasińska Beata, Krasiński Zbigniew, Tykarski Andrzej, Jemielity Marek
Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland.
Institute of Environmental Protection-National Research Institute, 02-170 Warsaw, Poland.
Toxics. 2024 Sep 26;12(10):697. doi: 10.3390/toxics12100697.
The survival benefit of surgical revascularization in multivessel coronary artery disease is well understood, though it can be modified by left ventricular dysfunction. Chronic exposure to air pollutants has gained more attention recently as a possible non-traditional morbidity and mortality cardiovascular risk factor. This study identified possible 5-year mortality risk factors related to postoperative left ventricular performance, including air pollutants.
There were 283 patients (244 (86%) males) with a median age of 65 (60-70) years enrolled in the retrospective analysis. All patients were referred for off-pump coronary artery revascularization due to chronic coronary syndrome that presented as a multivessel coronary artery disease. They were divided into three groups depending on the postoperative course of left ventricular fraction (LVEF 50% or more (169 patients), LVEF between 41 and 49% (61 patients), and LVEF 40% or less (53 patients)).
The overall survival rate was 84% (237 patients) in a median follow-up time of 5.3 (4.8-6.1) years. The median (Q1-Q3) chronic air pollution exposures for the analyzed group were 19.3 (16.9-22.4) μg/m for fine particles such as PM, 25.8 (22.5-29.4) μg/m for coarse particles such as PM, and 12.2 (9.7-14.9) μg/m for nitric dioxide (NO). The mortality in the first group (LVEF at least 50%) was 23 (13.6%), in the second group (LVEF 41-49%) was 9 (15%), and in the third group (LVEF 40% or less) was 14 (26%). The multivariable regression analysis for the five-year mortality risk in the first group revealed the predictive value of dyslipidemia (HR: 3.254, 95% CI: 1.008-10.511, = 0.049). The multivariable regression analysis for five-year mortality risk in the second group revealed the predictive value of dyslipidemia (HR: 3.391, 95% CI: 1.001-11.874, = 0.050) and PM (HR: 1.327, 95% CI: 1.085-1.625, = 0.006). In the third group (severely decreased LVEF), chronic PM exposure was found to be significant (HR: 1.518, 95% CI: 1.50-2.195, = 0.026) for 5-year mortality prediction.
Traditional risk factors, such as dyslipidemia, are pivotal in the 5-year mortality risk following surgical revascularization. Chronic exposure to ambient air pollutants such as PM may be an additional risk factor in patients with left ventricular dysfunction.
多支冠状动脉疾病患者接受外科血管重建术的生存获益已得到充分认识，不过其可能会因左心室功能障碍而改变。近年来，长期暴露于空气污染物中作为一种可能的非传统心血管发病和死亡风险因素，已受到更多关注。本研究确定了与术后左心室功能相关的可能的5年死亡风险因素，包括空气污染物。
283例患者（244例（86%）为男性）纳入回顾性分析，中位年龄65（60 - 70）岁。所有患者因表现为多支冠状动脉疾病的慢性冠状动脉综合征而接受非体外循环冠状动脉血管重建术。根据左心室射血分数（LVEF）的术后情况，他们被分为三组（LVEF 50%及以上（169例患者）、LVEF在41%至49%之间（61例患者）、LVEF 40%及以下（53例患者））。
在中位随访时间5.3（4.8 - 6.1）年时，总生存率为84%（237例患者）。分析组的细颗粒物（如PM）、粗颗粒物（如PM）和二氧化氮（NO）的慢性空气污染暴露中位值（四分位间距）分别为19.3（16.9 - 22.4）μg/m、25.8（22.5 - 29.4）μg/m和12.2（9.7 - 14.9）μg/m。第一组（LVEF至少50%）的死亡率为23例（13.6%），第二组（LVEF 41% - 49%）为9例（15%），第三组（LVEF 40%及以下）为14例（26%）。第一组5年死亡风险的多变量回归分析显示血脂异常具有预测价值（HR：3.254，95%CI：1.008 - 10.511，P = 0.049）。第二组5年死亡风险的多变量回归分析显示血脂异常（HR：3.391，95%CI：1.001 - 11.874，P = 0.050）和PM（HR：1.327，95%CI：1.085 - 1.625，P = 0.006）具有预测价值。在第三组（LVEF严重降低）中，发现长期暴露于PM对5年死亡率预测具有显著性（HR：1.518，95%CI：1.50 - 2.195，P = 0.026）。
传统风险因素，如血脂异常，在外科血管重建术后5年死亡风险中起关键作用。长期暴露于环境空气污染物如PM可能是左心室功能障碍患者的一个额外风险因素。
