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Air Pollution and Coronary Plaque Vulnerability and Instability: An Optical Coherence Tomography Study.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2022 Feb; Vol. 15 (2), pp. 325-342. Date of Electronic Publication: 2021 Oct 13. - Publication Year :
- 2022
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Abstract
- Objectives: We assessed the relationship between exposure to air pollutants and mechanisms of coronary instability evaluated by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS).<br />Background: Air pollution is an emerging key player in determining the residual risk of coronary events. However, pathophysiological mechanisms linking air pollution and coronary events have been not adequately investigated.<br />Methods: Patients with ACS undergoing OCT imaging were retrospectively selected. Mechanism of culprit lesion instability was classified as plaque rupture (PR) or intact fibrous cap (IFC) by OCT, and the presence of macrophage infiltrates (MØI) and thin-cap fibroatheroma (TCFA) at the culprit site was also assessed. Based on each case's home address, exposure to several pollutants was evaluated, including particulate matter 2.5 (PM2.5), PM10, and carbon monoxide (CO). Only patients with >2 years of available data on air pollution exposure prior to ACS were enrolled.<br />Results: We included 126 patients (median age: 67.0 years of age; IQR: 55.5-76.0; 97 male patients [77.0%]). Sixty-six patients (52.4%) had PR as the mechanism of plaque instability. Patients with PR were exposed to significantly higher PM2.5 levels than to IFC, and PM2.5 was independently associated with PR (odds ratio: 1.194; 95% CI: 1.036 to 1.377; P = 0.015). Moreover, exposure to higher levels of PM2.5 was independently associated with the presence of TCFA and of MØI at the culprit site. Interestingly, PM2.5, PM10, and Co levels were positively and significantly correlated with serum levels of C-reactive protein.<br />Conclusions: We provide novel insights into the missing link between air pollution and increased risk of coronary events. In particular, exposure to higher concentrations of air pollutants is associated with the presence of vulnerable plaque features and with plaque rupture as a mechanism of coronary instability. An enhanced systemic and plaque inflammatory activation may explain these findings.<br />Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Coronary Angiography
Coronary Vessels diagnostic imaging
Coronary Vessels pathology
Humans
Male
Predictive Value of Tests
Retrospective Studies
Tomography, Optical Coherence methods
Acute Coronary Syndrome diagnostic imaging
Acute Coronary Syndrome etiology
Acute Coronary Syndrome pathology
Air Pollution
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease epidemiology
Plaque, Atherosclerotic
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 15
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 34656488
- Full Text :
- https://doi.org/10.1016/j.jcmg.2021.09.008