Association between Air Pollution and Short-Term Outcome of ST-Segment Elevation Myocardial Infarction in a Tropical City, Kaohsiung, Taiwan

Jyun-Bin Huang; Kuo-Chen Huang; Ting-Min Hsieh; Chih-Min Tsai; Hao-Yi Hsiao; Chi-Yung Cheng; Fu-Jen Cheng

doi:10.3390/toxics11060541

Association between Air Pollution and Short-Term Outcome of ST-Segment Elevation Myocardial Infarction in a Tropical City, Kaohsiung, Taiwan

Toxics. 2023 Jun 19;11(6):541. doi: 10.3390/toxics11060541.

Authors

Jyun-Bin Huang^{1

2

3}, Kuo-Chen Huang^{2

3}, Ting-Min Hsieh^{2

4}, Chih-Min Tsai^{2

5}, Hao-Yi Hsiao^{2

6}, Chi-Yung Cheng^{2

3}, Fu-Jen Cheng^{2

3}

Affiliations

¹ Department of Emergency Medicine, Kaohsiung Municipal Feng Shan Hospital-Under The Management of Chang Gung Medical Foundation, Fengshan District, Kaohsiung 830, Taiwan.
² College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333, Taiwan.
³ Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
⁴ Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
⁵ Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Sung District, Kaohsiung City 833, Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.

Abstract

ST-segment elevation myocardial infarction (STEMI), one of the primary factors leading to global mortality, has been shown through epidemiological studies to have a relationship with short-term exposure to air pollutants; however, the association between air pollutants and the outcome of STEMI has not been well studied. The aim of this study was to estimate the impact of air pollutants on the outcomes of STEMI. Data on particulate matter <2.5 μm (PM_2.5), <10 μm (PM₁₀), nitrogen dioxide (NO₂), and ozone (O₃) at each of the 11 air monitoring stations in Kaohsiung City were collected between 1 January 2012 and 31 December 2017. Medical records of non-trauma patients aged > 20 years who had presented to the Emergency Department (ED) with a principal diagnosis of STEMI were extracted. The primary outcome measure was in-hospital mortality. After adjusting for potential confounders and meteorological variables, we found that an increase in the interquartile range (IQR) in NO₂ was associated with an elevated risk of in-hospital mortality in patients with STEMI. Moreover, there was an observed higher risk of in-hospital mortality associated with an increase in the IQR of NO₂ during the warm season, specifically in lag 3 (3 days prior to the onset, OR = 3.266; 95%CI: 1.203-8.864, p = 0.02). Conversely, an IQR increase in PM₁₀ was associated with an increased risk of in-hospital mortality in patients with STEMI in lag 3 (OR = 2.792; 95%CI: 1.115-6.993, p = 0.028) during the cold season. Our study suggests that exposure to NO₂ (during the warm season) and PM₁₀ (during the cold season) may contribute to a higher risk of poor prognosis in patients with STEMI.

Keywords: ST-segment elevation myocardial infarction; STEMI; air pollution; emergency department; nitrogen dioxide; particulate matter.

Grants and funding

This study was supported in part by research grants from Kaohsiung Chang Gung Memorial Hospital (grant number: CMRPG8M0201). The sponsor played no role in the study design, data collection, analysis, interpretation, writing of the report, or the decision to submit the article for publication.