Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS - Air Pollution Study).

There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas. A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas. The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS. A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM 2.5 , PM 10 , NO 2 , SO 2 , CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m3 of NO 2 concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009–1.257; P = 0.034, lag-0) and an increase of 1 mg/m3 in CO concentration (RR = 1.055, 95%CI = 1.010–1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m3 in NO 2 (OR = 1.062, 95%CI = 1.020–1.094; P = 0.005, lag-0), SO 2 (OR = 1.061, 95%CI = 1.010–1.116; P = 0.018, lag-4), PM 10 (OR = 1.010, 95%CI = 1.001–1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m3 in SO 2 (OR = 1.094, 95%CI = 1.030–1.162; P = 0.002, lag-1), PM 2.5 (OR = 1.041, 95%CI = 1.020–1.073; P < 0.001, lag-1), PM 10 (OR = 1.030, 95%CI = 1.010–1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area. The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO 2 on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO 2 on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM 10. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI. [Display omitted] • The first study with 6,000,000 person-years and seven-lag design in central Europe. • Comparison of pollution impact on ACS in areas of notably different air quality. • Short-term exposure to NO 2 influenced the prevalence of ACS in both areas. • In severely polluted area concentrations of PMs, SO 2 , NO 2 affected STEMI and NSTEMI. • No effect of air pollution on STEMI was noted in non-industrial area. [ABSTRACT FROM AUTHOR]