Abstract：
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide, with air pollution posing significant risks to cardiovascular health. The effect of air quality on heart failure (HF) readmission in acute myocardial infarction (AMI) patients is unclear.The aim of this study was to evaluate the role of a single measure of air pollution exposure collected on the day of first hospitalization.
METHODS: We retrospectively analyzed data from 12,857 acute coronary syndrome (ACS) patients (January 2015-March 2023). After multiple screenings, 4023 AMI patients were included. The air pollution data is updated by the automatic monitoring data of the national urban air quality monitoring stations in real time and synchronized to the China Environmental Monitoring Station. Cox proportional hazards regression assessed the impact of air quality indicators on admission and outcomes in 4013 AMI patients. A decision tree model identified the most susceptible groups.
RESULTS: After adjusting for confounders, NO2 (HR 1.009, 95% CI 1.004-1.015, P = 0.00066) and PM10 (HR 1.006, 95% CI 1.002-1.011, P = 0.00751) increased the risk of HF readmission in ST-segment elevation myocardial infarction (STEMI) patients. No significant effect was observed in non-STEMI (NSTEMI) patients (P > 0.05). STEMI patients had a 2.8-fold higher risk of HF readmission with NO2 > 13 μg/m3 (HR 2.857, 95% CI 1.439-5.670, P = 0.00269) and a 1.65-fold higher risk with PM10 > 55 μg/m3 (HR 1.654, 95% CI 1.124-2.434, P = 0.01064).
CONCLUSIONS: NO2 and PM10 are linked to increased HF readmission risk in STEMI patients, particularly when NO2 exceeds 13 μg/m3 and PM10 exceeds 55 μg/m3. Younger, less symptomatic male STEMI patients with fewer underlying conditions are more vulnerable to these pollutants.
METHODS: We retrospectively analyzed data from 12,857 acute coronary syndrome (ACS) patients (January 2015-March 2023). After multiple screenings, 4023 AMI patients were included. The air pollution data is updated by the automatic monitoring data of the national urban air quality monitoring stations in real time and synchronized to the China Environmental Monitoring Station. Cox proportional hazards regression assessed the impact of air quality indicators on admission and outcomes in 4013 AMI patients. A decision tree model identified the most susceptible groups.
RESULTS: After adjusting for confounders, NO2 (HR 1.009, 95% CI 1.004-1.015, P = 0.00066) and PM10 (HR 1.006, 95% CI 1.002-1.011, P = 0.00751) increased the risk of HF readmission in ST-segment elevation myocardial infarction (STEMI) patients. No significant effect was observed in non-STEMI (NSTEMI) patients (P > 0.05). STEMI patients had a 2.8-fold higher risk of HF readmission with NO2 > 13 μg/m3 (HR 2.857, 95% CI 1.439-5.670, P = 0.00269) and a 1.65-fold higher risk with PM10 > 55 μg/m3 (HR 1.654, 95% CI 1.124-2.434, P = 0.01064).
CONCLUSIONS: NO2 and PM10 are linked to increased HF readmission risk in STEMI patients, particularly when NO2 exceeds 13 μg/m3 and PM10 exceeds 55 μg/m3. Younger, less symptomatic male STEMI patients with fewer underlying conditions are more vulnerable to these pollutants.
摘要：
背景：心血管疾病（CVD）是全球死亡的主要原因，空气污染对心血管健康构成重大风险。空气质量对急性心肌梗死（AMI）患者心力衰竭（HF）再入院的影响尚不清楚。这项研究的目的是评估在首次住院当天收集的单一空气污染暴露措施的作用。
方法：我们回顾性分析了12,857例急性冠脉综合征（ACS）患者（2015年1月至2023年3月）的数据。经过多次筛查,纳入4023例AMI患者。空气污染数据由全国城市空气质量监测站自动监测数据实时更新，同步到中国环境监测总站。Cox比例风险回归评估了空气质量指标对4013例AMI患者入院和预后的影响。决策树模型确定了最易受影响的群体。
结果：调整混杂因素后，NO2（HR1.009，95%CI1.004-1.015，P=0.00066）和PM10（HR1.006，95%CI1.002-1.011，P=0.00751）增加了ST段抬高型心肌梗死（STEMI）患者再次入院的风险。非STEMI（NSTEMI）患者无明显疗效（P>0.05）。STEMI患者在NO2>13μg/m3时，HF再入院的风险高2.8倍（HR2.857，95％CI1.439-5.670，P=0.00269），在PM10>55μg/m3时，风险高1.65倍（HR1.654，95％CI1.124-2.434，P=0.01064）。
结论：NO2和PM10与STEMI患者的再入院风险增加有关，特别是当NO2超过13μg/m3和PM10超过55μg/m3时。年轻,症状较轻、基础疾病较少的男性STEMI患者更容易受到这些污染物的影响.
方法：我们回顾性分析了12,857例急性冠脉综合征（ACS）患者（2015年1月至2023年3月）的数据。经过多次筛查,纳入4023例AMI患者。空气污染数据由全国城市空气质量监测站自动监测数据实时更新，同步到中国环境监测总站。Cox比例风险回归评估了空气质量指标对4013例AMI患者入院和预后的影响。决策树模型确定了最易受影响的群体。
结果：调整混杂因素后，NO2（HR1.009，95%CI1.004-1.015，P=0.00066）和PM10（HR1.006，95%CI1.002-1.011，P=0.00751）增加了ST段抬高型心肌梗死（STEMI）患者再次入院的风险。非STEMI（NSTEMI）患者无明显疗效（P>0.05）。STEMI患者在NO2>13μg/m3时，HF再入院的风险高2.8倍（HR2.857，95％CI1.439-5.670，P=0.00269），在PM10>55μg/m3时，风险高1.65倍（HR1.654，95％CI1.124-2.434，P=0.01064）。
结论：NO2和PM10与STEMI患者的再入院风险增加有关，特别是当NO2超过13μg/m3和PM10超过55μg/m3时。年轻,症状较轻、基础疾病较少的男性STEMI患者更容易受到这些污染物的影响.
