Particulate air pollution as a risk factor for ST-segment depression in patients with coronary artery disease.
Particulate air pollution as a risk factor for ST-segment depression in patients with coronary artery disease.
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DOI：
10.1161/circulationaha.108.765669
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发表时间：
2008-09-23
期刊：
影响因子：
37.8
通讯作者：
Gold DR
中科院分区：
文献类型：
--
作者：
Chuang KJ;Coull BA;Zanobetti A;Suh H;Schwartz J;Stone PH;Litonjua A;Speizer FE;Gold DR
颗粒物（PM）与心血管疾病发病率和死亡率之间的关系已得到充分证实。PM诱导的缺血被认为是PM与不良心血管结局相关的潜在机制。在一项重复测量研究中，包括对48名43-75岁患者的5，979次观察，我们研究了环境污染与ST段水平变化的相关性，ST段水平变化在半小时内平均，通过24小时霍尔特心电图监测在改良V5位置测量。每例患者在经皮介入治疗心肌梗死、无梗死的急性冠状动脉综合征或无急性冠状动脉综合征的稳定性冠状动脉疾病后一年内最多观察4次。细颗粒物（PM2.5）和黑碳（BC）水平的升高预示着半小时平均ST段水平的下降。先前24小时平均BC水平的四分位数增加与ST段压低≥0.1 mm的风险增加1.50倍（95% CI：1.19，1.89）和半小时平均ST段水平降低−0.031 mm（95% CI：−0.042，−0.019）相关（连续结局）。在住院后的第一个月内效果最好，住院期间心肌梗死或糖尿病患者效果最好。ST段压低与心脏病患者暴露于PM2.5和BC的增加有关。在心脏事件发生后的第一个月内，心肌损伤患者发生污染相关ST段压低的风险可能最大。
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. In a repeated-measures study including 5,979 observations on 48 patients aged 43–75 years, we investigated associations of ambient pollution with ST-segment level changes averaged over half-hour periods, measured in the modified V5 position by 24-hr Holter electrocardiogram monitoring. Each patient was observed up to 4 times within one 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 (PM2.5) and black carbon (BC) levels predicted depression of half-hour averaged ST-segment levels. An interquartile increase in the previous 24-h mean BC level was associated with a 1.50-fold increased in risk of ST-segment depression ≥0.1 mm (95% CI: 1.19, 1.89) and a −0.031 mm (95% CI: −0.042, −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. ST-segment depression is associated with increased exposure to PM2.5 and BC 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.