Myocardial infarction, ST-elevation and non-ST-elevation myocardial infarction and modelled daily pollution concentrations: a case-crossover analysis of MINAP data

TitleMyocardial infarction, ST-elevation and non-ST-elevation myocardial infarction and modelled daily pollution concentrations: a case-crossover analysis of MINAP data
Publication TypeJournal Article
Year of Publication2016
AuthorsButland B.K, Atkinson R.W, Milojevic A., Heal M.R, Doherty R.M, Armstrong B.G, MacKenzie I.A, Vieno M., Lin C., Wilkinson P.
JournalOpen HeartOpen HeartOpen Heart
Volume3
Paginatione000429
Date Published10/2016
ISBN Number2053-3624
Accession Number27621827
Abstract

OBJECTIVES: To investigate associations between daily concentrations of air pollution and myocardial infarction (MI), ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). METHODS: Modelled daily ground-level gaseous, total and speciated particulate pollutant concentrations and ground-level daily mean temperature, all at 5 kmx5 km horizontal resolution, were linked to 202 550 STEMI and 322 198 NSTEMI events recorded on the England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. The study period was 2003-2010. A case-crossover design was used, stratified by year, month and day of the week. Data were analysed using conditional logistic regression, with pollutants modelled as unconstrained distributed lags 0-2 days. Results are presented as percentage change in risk per 10 microg/m(3) increase in the pollutant relevant metric, having adjusted for daily mean temperature, public holidays, weekly influenza consultation rates and a sine-cosine annual cycle. RESULTS: There was no evidence of an association between MI or STEMI and any of O3, NO2, PM2.5, PM10 or selected PM2.5 components (sulfate and elemental carbon). For NSTEMI, there was a positive association with daily maximum 1-hour NO2 (0.27% (95% CI 0.01% to 0.54%)), which persisted following adjustment for O3 and adjustment for PM2.5. The association appeared to be confined to the midland and southern regions of England and Wales. CONCLUSIONS: The study found no evidence of an association between the modelled pollutants (including components) investigated and STEMI but did find some evidence of a positive association between NO2 and NSTEMI. Confirmation of this association in other studies is required.

Short TitleOpen heartOpen heart
Alternate JournalOpen heart