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Minerva Medica 2021 Jul 26

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. MERCADÉ 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 of Rome, Latina, Italy; 2 Mediterranea Cardiocentro, Napoli, Italy; 3 Department of Cardiovascular Imaging, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina; 4 Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina; 5 Agencia de Proteccion Ambiental (APRA) de la Ciudad de Buenos Aires, Buenos Aires, Argentina; 6 Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina; 7 Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 8 Department of Interventional Cardiology, Hospital Ramos Mejia, Buenos Aires, Argentina; 9 Department of Interventional Cardiology, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina; 10 Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina; 11 Department of Interventional Cardiology, Clínica Santa Isabel, Buenos Aires, Argentina; 12 Servicio de Cardiología Intervencionista, Diagnóstico Mediter-Sanatorio Dr Julio Méndez, Buenos Aires, Argentina; 13 Department of Interventional Cardiology, Hospital San Juan de Dios, Buenos Aires, Argentina; 14 Department of Interventional Cardiology, Hospital Britanico, Buenos Aires, Argentina; 15 Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina; 16 Department of Interventional Cardiology, Hospital Aleman, Buenos Aires, Argentina; 17 Department of Interventional Neuroradiology, Instituto Medico ENERI, Clinica La Sagrada, Buenos Aires, Argentina; 18 UOC UTIC, Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy; 19 Universidad de Buenos Aires, Facultad de Ciencias sociales, Instituto de Investigaciones Gino Germani, 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 Coronavrus 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 (eg 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; Pollution; ST-elevation myocardial infarction; Weather

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