Efectos de la contaminación atmosférica sobre la incidencia, mortalidad y arritmias ventriculares en el síndrome coronario agudo con elevación del ST

Abstract

Background. Knowledge of the role of air pollution (AP) as a trigger for ST elevation acute coronary syndrome (STEACS) is scarce and controversial. On the other hand, the effect of AP on severity in the acute phase of STEACS in terms of mortality and ventricular arrhythmias is not known. Objective: To determine if AP increases the incidence, mortality and ventricular arrhythmias in the STEACS. Methods. The study was carried out in the Regió Sanitària of Barcelona between January 2010 and December 2011. In a prospective way, through the Codi IAM Registry, the time series of the number of STEACS and their mortality and associated ventricular arrhythmias were obtained. The meteorological variables and the concentrations of the main air pollutants have also been represented by time series. Three cohorts with geographic and temporal criteria have been defined to minimize exposure bias. The magnitude of the associations has been estimated using an autoregressive Poisson regression model. Association and impact measures have been obtained. The analyzes were performed using the software RStudio 0.97.551. Results. The daily number of STEACS was associated with increments of 10 units (micrograms per cubic meter, except lead measured in nanograms per cubic meter) of particulate matter (PM) 2.5 with a relative risk (RR) of 1.005 [ confidence interval (CI) 95%: 1.001-1.010], PM 10 with RR of 1.004 (95% CI: 1.000-1.007), nitrogen dioxide with RR of 1.002 (95% CI: 1.000-1.003), lead with a RR of 1.0260 (95% CI: 1.0027-1.0480) and nitrogen monoxide with an RR of 1.0140 (95% CI: 1.0009-1.0270). Mortality was associated with increases in 10 units of PM 2.5 and PM 10 with an RR of 1.042 (95% CI: 1012-1.070) and RR of 1.036 (95% CI: 1011-1.059), respectively. Ventricular arrhythmias were associated with increments in 10 units of PM 2.5 with a RR of 1.016 (95% CI: 1.003-1.028). The proportion of attributable risk reached 4.58% in lead exposure to trigger a STEACS, and 11.9% and 3.76% in exposure to PM 2.5 and its relationship with mortality and ventricular arrhythmias respectively. Conclusions. Short-term exposure to PM2.5, PM 10, monoxide and dioxide nitrogen and lead increases the incidence of STEACS. Exposure to PM 2.5 and PM 10 increases acute phase mortality and PM 2.5 increases the risk of ventricular arrhythmias. The proportion of severe acute phase STEACS complications that could be prevented reaches a maximum of 11.9% in reducing mortality if exposure to PM 2.5 is avoided. It should be noted that PM 2.5 turns out to be the most harmful pollutant so that sociopolitical efforts should be directed at lowering their environmental concentrations in the first place.

Date of Award	13 Sept 2017
Original language	Spanish
Supervisor	Antonio David Garcia Dorado García (Director)