Huang Jia, He Qinglin, Jiang Yixuan, Wong Jennifer Ming Jen, Li Jianxuan, Liu Jiangdong, Wang Ruochen, Chen Renjie, Dai Yuxiang, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai 200032, China.
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai 200032, China.
Eur Heart J. 2025 Feb 3;46(5):439-450. doi: 10.1093/eurheartj/ehae711.
Although non-optimum ambient temperature is a major non-traditional risk factor for acute myocardial infarction, there is no prior knowledge on whether non-optimum ambient temperature could differentially affect myocardial infarction with obstructive coronary artery disease (MI-CAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA).
Using the Chinese Cardiovascular Association database-Chest Pain Center Registry, a nationwide, time-stratified, case-crossover investigation was conducted from 2015 to 2021. Meteorological data were obtained from an established satellite-based model, and daily exposures were assigned according to the onset of myocardial infarction in each patient. A conditional logistic regression model combined with distributed lag non-linear models (10 days) was used to estimate the exposure-response relationships.
A total of 83 784 MINOCA patients and 918 730 MI-CAD patients were included. The risk of MINOCA and MI-CAD associated with low temperature occurred at lag 2 day and lasted to 1 week. Extremely low temperature was associated with a substantially greater odds ratio (OR) of MINOCA [OR 1.58, 95% confidence interval (CI) 1.31-1.90] than MI-CAD (unmatched: OR 1.32, 95% CI 1.23-1.43; equally matched by age and sex: OR 1.25, 95% CI 1.04-1.50), compared with the corresponding reference temperatures (30°C, 35°C, and 30°C). Stronger associations were observed for patients who were aged ≥65 years, female, or resided in the south. There was no significant difference for the impacts of high temperature on MINOCA and MI-CAD.
This nationwide study highlights the particular susceptibility of MINOCA patients to ambient low temperature compared with that of MI-CAD patients.
尽管非适宜环境温度是急性心肌梗死的主要非传统风险因素，但对于非适宜环境温度是否会对伴有阻塞性冠状动脉疾病的心肌梗死（MI-CAD）和非阻塞性冠状动脉心肌梗死（MINOCA）产生不同影响，此前尚无相关认知。
利用中国心血管协会数据库 - 胸痛中心注册系统，于2015年至2021年开展了一项全国性、时间分层的病例交叉调查。气象数据来自一个既定的基于卫星的模型，并根据每位患者心肌梗死的发病时间确定每日暴露情况。采用条件逻辑回归模型结合分布滞后非线性模型（10天）来估计暴露 - 反应关系。
共纳入83784例MINOCA患者和918730例MI-CAD患者。与低温相关的MINOCA和MI-CAD风险在滞后2天出现，并持续至1周。与相应的参考温度（30°C、35°C和30°C）相比，极低温度与MINOCA的优势比（OR）显著高于MI-CAD（未匹配：OR 1.58，95%置信区间[CI] 1.31 - 1.90；年龄和性别匹配：OR 1.25，95% CI 1.04 - 1.50）。在年龄≥65岁、女性或居住在南方的患者中观察到更强的关联。高温对MINOCA和MI-CAD的影响无显著差异。
这项全国性研究突出了MINOCA患者相较于MI-CAD患者对环境低温的特殊易感性。
