Key result
Summer days are linked to ~9% lower STEMI incidence in older women.
Why the study?
The precise triggers determining the timing of acute STEMI events remain incompletely understood, and the effects of multiple short-term environmental exposures on STEMI onset have not been sufficiently investigated at the population level.
Do extreme environmental conditions and air pollutants affect the daily incidence of STEMI in Southeast Germany?
Observational (n=57,896)
Do extreme environmental conditions and air pollutants affect the daily incidence of STEMI in Southeast Germany?
Specific environmental patterns such as summer days, hot days, cold-wave duration, sea-level pressure, and ozone are associated with short-term changes in STEMI incidence in Southeast Germany, particularly among patients aged ≥60 years.
Introduction ST-elevation myocardial infarction (STEMI) is a life-threatening cardiovascular emergency requiring immediate reperfusion therapy and continuous availability of catheterization facilities. Despite well-established risk factors, the precise triggers determining the timing of acute events remain incompletely understood. Growing evidence suggests that short-term environmental exposures may contribute to the onset of STEMI. Purpose However, the effects of multiple environmental factors have not been sufficiently investigated at the population level. Therefore, the ALERT-ITS project analyses the association between extreme environmental conditions and the incidence of STEMI. Methods We performed a retrospective population-based time-series (2009-2023) analysis of anonymised statutory health insurance data from a German health insurance institute. Daily STEMI cases, defined by ICD-10-GM criteria, were stratified by sex and age (≥60 vs. <60 years) and assigned to nationwide bio-meteorological regions, with a focus on Southeast Germany. Meteorological and air-quality data included daily mean sea-level pressure (SLP), summer days (SD), hot days (HD), tropical nights (TN), cold-wave duration (CD), and ozone (O₃). Associations were estimated using Quasi-Poisson generalized additive models with distributed lags (weather ≤10 days; pollutants ≤7 days), adjusting for seasonality, long-term trends, and weekday effects. Results During the study period, a total of 57,896 confirmed STEMI cases were identified in Southeast Germany. In men ≥60 years, SD (p = 0.044), HD (p = 0.037) and O3 (p = 0.026) were significant predictors. In women ≥60 years, SD (p = 0.001), HD (p = 0.004), CD (p < 0.001), and SLP (p = 0.020) showed significant associations. No predictor reached statistical significance in men <60 years, whereas in women <60 years, SD (p = 0.010) and CD (p = 0.008) were significant. The strongest linear association was observed for SD in women ≥60 years (p = 0.0012), with a relative risk of 0.91 (95% CI 0.85–0.96), corresponding to a 9.3% relative reduction in STEMI incidence on summer days compared with non-summer days. Conclusion In Southeast Germany, specific environmental patterns were associated with short-term changes in STEMI incidence, particularly among older patients. Integrating these insights into planning strategies may enhance proactive resource allocation in acute cardiovascular care.
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Branz et al. (2026) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=57,896). Extreme environmental conditions (sea-level pressure, summer days, hot days, tropical nights, cold-wave duration, and ozone) vs. Non-extreme environmental conditions (e.g., non-summer days) was evaluated on Daily STEMI incidence (strongest linear association reported for summer days in women ≥60 years) (RR 0.91, 95% CI 0.85-0.96, p=0.0012). Summer days were associated with a 9.3% relative reduction in STEMI incidence compared with non-summer days in women ≥60 years (RR 0.91; 95% CI 0.85-0.96; p=0.0012).
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