Home Medizin Ist Luftverschmutzung mit einem erhöhten Auftreten von Myokardinfarkten und kardiogenem Schock verbunden?

Ist Luftverschmutzung mit einem erhöhten Auftreten von Myokardinfarkten und kardiogenem Schock verbunden?

von NFI Redaktion

In a recent study published in Scientific Reports, researchers from Korea investigated the relationship between prolonged exposure to air pollution (AP) and ST-elevation myocardial infarction (STEMI) as well as cardiogenic shock in the hospital.

They found that exposure to fine particulate matter (PM) with a diameter < 10 µm (PM10) was associated with an increased risk of STEMI compared to non-STEMI (NSTEMI).

Furthermore, PM10 and sulfur dioxide (SO2) exposure were found to be associated with an increased incidence of cardiogenic shock in the hospital.

Study: Long-term air pollution is associated with a higher incidence of ST-elevation myocardial infarctions and cardiogenic shock in the hospital. Image credit: TR STOK/Shutterstock.comStudy: Long-term exposure to air pollution is associated with a higher incidence of ST-elevation myocardial infarctions and cardiogenic shock in the hospital. Image credit: TR STOK/Shutterstock.com

Background

Ischemic heart diseases (IHD) such as acute myocardial infarction (AMI) pose a significant health challenge globally, particularly in the Asia-Pacific region.

There is evidence to suggest that both short- and long-term exposure to AP in individuals with coronary heart disease (CHD) is associated with complications such as hospitalization, readmission, and early death.

While previous studies have examined the short-term effects of AP on AMI, there is limited research on long-term outcomes, especially in terms of the relative occurrence of STEMI and NSTEMI, as well as the development of cardiogenic shock.

STEMI typically involves complete blockage of the coronary vessels and active damage to the heart muscle, while NSTEMI involves partial blockage with less damage to the heart muscle.

Previous research has shown that AP exposure, both short- and long-term, is associated with adverse clinical outcomes in AMI patients.

In the present study, the same research group built upon their previous findings to investigate the potential relationship between long-term AP exposure, STEMI, and cardiogenic shock.

About the Study

The study included participants from the Korean Acute Myocardial Infarction Registry (KAMIR) and the KAMIR-National Institutes of Health (NIH). This was a nationwide prospective multicenter registry series aimed at establishing treatment guidelines and analyzing the clinical characteristics of Korean AMI patients.

Participants were enrolled from 2006 to 2015. Exclusion criteria for patients included symptom onset before 2006, missing date of onset, age < 18 years, and lack of a diagnosis of myocardial infarction (MI) upon discharge. A total of 45,619 participants were included – 20,526 with NSTEMI and 25,093 with STEMI.

Hourly AP concentrations obtained from the Korean Ministry of Environment were measured at 329 nationwide monitoring stations using various methods.

Data conversion into daily averages and calculation of yearly averages prior to the symptom day were performed, with PM2.5 excluded due to non-availability. The symptom date was defined as the date of MI symptom onset.

The diagnosis of AMI included elevated cardiac biomarkers, typical electrocardiogram (ECG) changes, and clinical symptoms, with STEMI identified by new ST elevations ≥ 1 mm in ≥ 2 contiguous leads.

NSTEMI patients exhibited positive biomarkers without STEMI ECG findings. Cardiogenic shock was defined by low blood pressure requiring support to maintain it and signs of pulmonary congestion. Complications were considered if they occurred after admission.

Information on various cardiovascular risk factors (diabetes mellitus, family history of coronary heart disease, hypertension, dyslipidemia, previous cardiovascular diseases, heart failure, past cerebrovascular diseases (CVA), and smoking) was self-reported by the patients.

The statistical analysis included the use of the chi-square test, Fisher’s exact test, Student’s t-test, Mann-Whitney rank test, Kolmogorov-Smirnov test, generalized logistic mixed-effect models, correlation analysis, variance inflation factor, odds ratios (OR), logistic regression, and subgroup analysis.

Results and Discussion

Compared to NSTEMI patients, STEMI patients were younger, predominantly male, more frequent smokers, had fewer underlying chronic conditions, and exhibited more severe angiographic and clinical features, including a higher rate of cardiogenic shock complications during the index hospitalization.

PM10 showed a significant association with increased STEMI incidence (OR 1.009), and both PM10 and SO2 were associated with a higher risk of cardiogenic shock complications in the hospital (OR 1.03 and 1.104, respectively).

Conversely, an increase in O3 was negatively correlated with cardiogenic shock (OR 0.891). Subgroup analysis revealed a significant association between a decrease in STEMI incidence and an increase in NO2 among CVA patients.

The study emphasizes the role of minimizing exposure to elevated AP levels in reducing MI risk and mortality in high- and low-risk groups.

However, the results are limited by the study design and the limited sample data for PM2.5, constraints in associating with clinical events, lack of PM2.5 data for years before 2015, potential misclassification of patient exposure, and the possibility of variations and input errors in multicenter registry data, highlighting the need for cautious interpretation.

Conclusion

In conclusion, the present study suggests that increased concentrations of air pollutants, particularly particulate matter, represent an environmental risk and are associated with a higher incidence of STEMI.

Additionally, both PM10 and SO2 levels are considered risk factors for the complication of cardiogenic shock in the hospital following a myocardial infarction.

The results underscore the urgent need to implement strategies and clinical interventions at the policy level to reduce AP exposure, potentially prevent STEMI, and decrease the risk of severe cardiovascular complications to improve public health outcomes.

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