Long-term Air Pollution Exposure are Associated with Higher Incidence of ST-elevation Myocardial Infarction and In-hospital Cardiogenic Shock

Background Previous studies have reported the association between myocardial infarction (MI) and air pollution (AP). However, limited information is available regarding the long-term effects of AP on the relative incidence rates of ST-elevation MI (STEMI) and Non-ST-elevation MI (NSTEMI). Methods Study subjects were enrolled from the Korea Acute MI registry (KAMIR) and KAMIR-National Institutes of Health (NIH). A total of 45,619 eligible patients with AMI were enrolled between January 2006 and December 2015. We investigated the association between long-term exposure to AP and compared the incidence of STEMI with those of NSTEMI. Mixed-effect regression models were used to examine the association between the annual average ambient AP before MI onset and the incidence of STEMI compared with that of NSTEMI, and to evaluate the association of AP with the incidence of in-hospital cardiogenic shock. Results After mixed-effect regression model analysis, each 1 μg/m 3 increase in particulate matter (PM) 10 µm or less in diameter (PM 10 ) was associated with increased incidence of STEMI compared with NSTEMI (odds ratio [OR]:1.009, 95% Confidence Interval [CI]: 1.002–1.016; p = 0.012). For in-hospital cardiogenic shock complication, each 1 μg/m 3 increase in PM 10 and 1 part per billion increase in SO 2 were associated with increased risk, PM 10 (OR:1.033, 95% CI, 1.018–1.050; p < 0.001), SO 2 (OR:1.104, 95% CI, 1.006–1.212; p = 0.037), respectively. Conclusion A high concentration of air pollutants, particularly PM 10, was an environmental risk factor for an increase incidence of development of STEMI. PM 10 and SO 2 were found to be risk factors for in-hospital cardiogenic shock complications. Policy-level strategies and clinical efforts to reduce AP exposure are necessary to prevent the incidence of STEMI and severe cardiovascular complications.