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. 2008 Sep 23;118(13):1314-20.
doi: 10.1161/CIRCULATIONAHA.108.765669. Epub 2008 Sep 8.

Particulate air pollution as a risk factor for ST-segment depression in patients with coronary artery disease

Kai Jen Chuang  1 , Brent A Coull, Antonella Zanobetti, Helen Suh, Joel Schwartz, Peter H Stone, Augusto Litonjua, Frank E Speizer, Diane R Gold
Affiliations

Particulate air pollution as a risk factor for ST-segment depression in patients with coronary artery disease

Kai Jen Chuang et al. Circulation. .

Abstract

Background: The association of particulate matter (PM) with cardiovascular morbidity and mortality is well documented. PM-induced ischemia is considered a potential mechanism linking PM to adverse cardiovascular outcomes.

Methods and results: In a repeated-measures study including 5979 observations on 48 patients 43 to 75 years of age, we investigated associations of ambient pollution with ST-segment level changes averaged over half-hour periods measured in the modified V(5) position by 24-hour Holter ECG monitoring. Each patient was observed up to 4 times within 1 year after a percutaneous intervention for myocardial infarction, acute coronary syndrome without infarction, or stable coronary artery disease without acute coronary syndrome. Elevation in fine particles (PM(2.5)) and black carbon levels predicted depression of half-hour-averaged ST-segment levels. An interquartile increase in the previous 24-hour mean black carbon level was associated with a 1.50-fold increased risk of ST-segment depression > or =0.1 mm (95% CI, 1.19 to 1.89) and a -0.031-mm (95% CI, -0.042 to -0.019) decrease in half-hour-averaged ST-segment level (continuous outcome). Effects were greatest within the first month after hospitalization and for patients with myocardial infarction during hospitalization or with diabetes.

Conclusions: ST-segment depression is associated with increased exposure to PM(2.5) and black carbon in cardiac patients. The risk of pollution-associated ST-segment depression may be greatest in those with myocardial injury in the first month after the cardiac event.

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Figures

Figure 1
Figure 1
The effects of fine particles (PM2.5) and black carbon (BC) on half-hour averaged ST-segment level estimated by single-pollutant models, scaled to interquartile range (IQR) increase in levels for individual hour mean. Error bars indicate 95% confidence intervals.
Figure 2
Figure 2
The effects of fine particles (PM2.5) and black carbon (BC) on half-hour averaged ST-segment depression ≥ 0.1 mm below a subject-visit setpoint, as estimated by additive mixed logistic regression models, scaled to interquartile range (IQR) increase in levels for individual hour mean. Error bars indicate 95% confidence intervals.
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