The Role of Environmental PM_2.5 in Admission Acute Heart Failure in ST-Elevation Myocardial Infarction patients - An Observational Retrospective Study

Background: Air pollution with increased concentrations of fine (<2.5 μm) particulate matter (PM_2.5) increases the risk of cardiovascular morbidity and mortality. Even short-term increase of PM_2.5 may help trigger ST-elevation myocardial infarction (STEMI) and heart failure (HF) in susceptible individuals, even in areas with good air quality.

Purpose: To evaluate the role of PM_2.5 levels ≥20 µg/m³ in admission acute HF in STEMI patients.

Materials and methods: In 290 STEMI patients with the leading reperfusion strategy primary percutaneous coronary intervention (PPCI), we retrospectively studied independent predictors of admission acute HF and included admission demographic and clinical data as well as ambient PM_2.5 levels ≥20 µg/m³. We defined admission acute HF in STEMI patients as classes II-IV by Killip Kimball classification.

Results: Acute admission HF was observed in 34.5% of STEMI patients. PPCI was performed in 87.1% of acute admission HF patients and in 94.7% non-HF patients (p= 0.037). Significant independent predictors of acute admission HF were prior diabetes (OR 2.440, 95% CI 1.100 to 5.400, p=0.028), admission LBBB (OR 10.190, 95% CI 1.160 to 89.360, p=0.036), prior resuscitation (OR 2.530, 95% CI 1.010 to 6.340, p=0.048), admission troponin I≥5µg/l (OR 3.390, 95% CI 1.740 to 6.620, p<0.001), admission eGFR levels (0.61, 95% CI 0.52 to 0.72, p < 0.001), and levels of PM_2.5 ≥20 µg/m³ (OR 2.140, 95% CI 1.005 to 4.560, p=0.049) one day before admission.

Conclusion: Temporary short-term increase in PM_2.5 levels (≥20 µg/m³) one day prior to admission in an area with mainly good air quality was among significant independent predictors of acute admission HF in STEMI patients.