Abstract
BackgroundEpidemiology studies have shown a consistently increased risk of acute myocardial infarction (AMI) correlated with particulate matter (PM) exposure. However, little is known about the association with specific AMI subtypes. In this work, we investigated the association between short-term PM exposure and emergency department visits (EDVs) for AMI, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI).MethodsWe based this case-crossover study on 2749 patients from Chaoyang District hospitalized with AMI in Anzhen Hospital during 2014. Meteorological and air pollution data were collected during this period. We used a time-stratified case-crossover design with lag model, adjusted for meteorological conditions and/or other gaseous pollutants, to estimate risk of EDVs for AMI, STEMI, and NSTEMI. We conducted stratified analyses by gender, age, season, and comorbid conditions to examine potential effect modification.ResultsWe found that each 10 µg/m3 increment of PM2.5 concentration (1-day lagged) was associated with an increased risk of EDVs for STEMI (OR 1.05; 95% CI, 1.00–1.11). We found no association of PM2.5 concentration with overall AMI or NSTEMI. No effect modification was found when stratified by gender, season, or comorbid conditions, even though the effect size was larger in patients who were male, smokers, and comorbid with hypertension. Patients aged ≥65 years showed a significantly increased risk of STEMI associated with PM2.5 in the previous day than those aged <65 years.ConclusionsOur study indicated a transient effect of short-term PM2.5 exposure on EDVs for STEMI. Patients aged ≥65 years appeared to be particularly susceptible. Our findings suggest that studies of the association between PM exposure and AMI should consider AMI subtypes, lag times, and individual characteristics.
Highlights
Ambient particulate matter (PM) air pollution has become one of the most important issues in Beijing over the last few years
We investigated the risk of acute myocardial infarction (AMI), ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI) associated with each 10 μg/m3 increase in mean daily PM concentration at 0–5 separated lagged days to get the greatest risk estimates
Our study found that short-term exposure to elevated PM levels in the previous day was associated with increased emergency department visits (EDVs) for STEMI, for elderly patients (≥65 years)
Summary
Ambient particulate matter (PM) air pollution has become one of the most important issues in Beijing over the last few years. In the Harvard Six Cities Study[3] and the American Cancer Society Study on Particulate Air Pollution and Mortality,[4] PM2.5 was substantially associated with cardiovascular mortality. A substantial number of case-crossover studies have explored the association between short-term ambient PM exposure and risk of acute myocardial infarction (AMI).[5,6,7,8,9,10,11,12,13,14,15,16] The majority of these studies indicated that elevated concentrations of particulate matter in the air may transiently elevate the risk of MIs with short-term exposure, odds ratios (ORs) are relatively small. We used a time-stratified case-crossover design with lag model, adjusted for meteorological conditions and/or other gaseous pollutants, to estimate risk of EDVs for AMI, STEMI, and NSTEMI. Our findings suggest that studies of the association between PM exposure and AMI should consider AMI subtypes, lag times, and individual characteristics
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