ORIGINAL ARTICLE   

Minerva Medica 2022 December;113(6):950-8

DOI: 10.23736/S0026-4806.21.07748-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Interplay between climate, pollution and COVID-19 on ST-elevation myocardial infarction in a large metropolitan region

Giuseppe BIONDI-ZOCCAI ^{1, 2} ✉, Gaston A. RODRIGUEZ-GRANILLO ^{3, 4}, Juan M. MERCADE ⁵, Laura DAWIDOWSKI ⁶, Ignacio M. SEROPIAN ⁷, Fernando COHEN ⁷, Cristiano STURMER-RAMOS ⁸, Amalia DESCALZO ⁹, Bibiana RUBILAR ⁹, Matias SZTEJFMAN ¹⁰, Ezequiel ZAIDEL ¹⁰, Cristian PAZOS ¹¹, Jorge LEGUIZAMON ¹¹, German CAFARO ¹², Mariano VISCONTI ¹², Pablo BAGLIONI ¹³, Agustin NOYA ¹⁴, Lucia FONTANA ³, Matias RODRIGUEZ-GRANILLO ¹⁵, Hernan PAVLOVSKY ¹⁵, Jose A. ALVAREZ ^{14, 16}, Pedro LYLYK ¹⁷, Francesco VERSACI ¹⁸, Rosana ABRUTZKY ¹⁹

¹ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; ² Mediterranea Cardiocentro, Naples, Italy; ³ Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina; ⁴ National Council of Scientific and Technical Investigations, Buenos Aires, Argentina; ⁵ Agencia de Proteccion Ambiental (APRA), Buenos Aires, Argentina; ⁶ Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina; ⁷ Department of Interventional Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina; ⁸ Department of Interventional Cardiology, Ramos Mejia Hospital, Buenos Aires, Argentina; ⁹ Department of Interventional Cardiology ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina; ¹⁰ Department of Interventional Cardiology, Guemes Sanatorium, Buenos Aires, Argentina; ¹¹ Department of Interventional Cardiology, Santa Isabel Clinic, Buenos Aires, Argentina; ¹² Service of Interventional Cardiology, Diagnóstico Mediter-Sanatorio Dr Julio Méndez, Buenos Aires, Argentina; ¹³ Department of Interventional Cardiology, San Juan de Dios Hospital, Buenos Aires, Argentina; ¹⁴ Department of Interventional Cardiology, British Hospital, Buenos Aires, Argentina; ¹⁵ Department of Interventional Cardiology, Otamendi Sanatorium, Buenos Aires, Argentina; ¹⁶ Department of Interventional Cardiology, German Hospital, Buenos Aires, Argentina; ¹⁷ Department of Interventional Neuroradiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina; ¹⁸ Unit of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy; ¹⁹ University of Buenos Aires, Faculty of Social Sciences, Gino Germani Investigation Institute, Buenos Aires, Argentina

BACKGROUND: Collective risk factors such as climate and pollution impact on the risk of acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). There is limited data however on the precise temporal and independent association between these factors and STEMI, and the potentially interacting role of government policies against Coronavirus disease 2019 (COVID-19), especially for Latin America.
METHODS: We retrospectively collected aggregate data on daily STEMI admissions at 10 tertiary care centers in the Buenos Aires metropolitan area, Argentina, from January 1, 2017 to November 30, 2020. Daily measurements for temperature, humidity, atmospheric pressure, wind direction, wind speed, and rainfall, as well as carbon monoxide (CO), nitrogen dioxide, and particulate matter <10 µm (PM10), were retrieved. Exploratory analyses focused on key COVID-19-related periods (e.g. first case, first lockdown), and Stringency Index quantifying the intensity of government policy response against COVID-19.
RESULTS: A total of 1498 STEMI occurred over 1430 days, for an average of 0.12 STEMI per center (decreasing from 0.130 in 2018 to 0.102 in 2020, P=0.016). Time series analysis showed that lower temperature and higher concentration of CO and PM10 were all significantly associated with an increased rate of STEMI (all P<0.05), whereas COVID-19 outbreak, lockdown, and stringency of government policies were all inversely associated with STEMI (all P<0.05). Notably, environmental features impacted as early as 28 days before the event (all P<0.05), even if same or prior day associations proved stronger (all P<0.05). Multivariable analysis suggested that maximum temperature (P=0.001) and PM10 (P=0.033) were the strongest predictor of STEMI, even after accounting for COVID-19-related countermeasures (P=0.043).
CONCLUSIONS: Lower temperature and higher concentrations of CO and PM10 are associated with significant increases in the rate of STEMI in a large Latin American metropolitan area. The reduction in STEMI cases seen during the COVID-19 pandemic is at least in part mediated by improvements in pollution, especially reductions in PM10.

KEY WORDS: Acute coronary syndrome; Climate; COVID-19; Environment; ST-elevation myocardial infarction; Weather