title: Air pollution and ST-elevation myocardial infarction: A case-crossover study of the Belgian STEMI registry 2009-2013.
abstract: BACKGROUND
  Previous studies have shown that air pollution particulate matter (PM) is associated with an increased risk for myocardial infarction. The effects of air pollution on the risk of ST-elevation myocardial infarction (STEMI), in particular the role of gaseous air pollutants such as NO2and O3and the susceptibility of specific populations, are still under debate.
  
  
  METHODS
  All patients entered in the Belgian prospective STEMI registry between 2009 and 2013 were included. Based on a validated spatial interpolation model from the Belgian Environment Agency, a national index was used to address the background level of air pollution exposure of Belgian population. A time-stratified and temperature-matched case-crossover analysis of the risk of STEMI was performed.
  
  
  RESULTS
  A total of 11,428 STEMI patients were included in the study. Each 10μg/m3increase in PM10, PM2.5 and NO2was associated with an increased odds ratio (ORs) of STEMI of 1.026 (CI95%: 1.005-1.048), 1.028 (CI95%: 1.003-1.054) and 1.051 (CI95%: 1.018-1.084), respectively. No effect of O3was found. STEMI was associated with PM10 exposure in patients ≥75y.o. (OR: 1.046, CI95%: 1.002-1.092) and with NO2in patients ≤54y.o. (OR: 1.071, CI95%: 1.010-1.136). No effect of air pollution on cardiac arrest or in-hospital STEMI mortality was found.
  
  
  CONCLUSIONS
  PM2.5 and NO2exposures incrementally increase the risk of STEMI. The risk related to PM appears to be greater in the elderly, while younger patients appear to be more susceptible to NO2exposure.
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium. Electronic address: jean-francois.argacha@uzbrussel.be.
authors.forename: J F
authors.initials: JF
authors.lastname: Argacha
authors.affiliation: Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Collart
authors.affiliation: Cardiology Department, Erasme Hospital, ULB, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Wauters
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Kayaert
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Lochy
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Schoors
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Sonck
authors.affiliation: Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: de Vos
authors.affiliation: Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Forton
authors.affiliation: Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Brasseur
authors.affiliation: Division of Cardiology, Cliniques Universitaires Saint Luc Hospital and Pole de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Brussels, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Beauloye
authors.affiliation: Cardiology Department, Ghent University Hospital, Gent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Gevaert
authors.affiliation: Cardiology Department, Mont Godine Hospital, UCL, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Evrard
authors.affiliation: Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Coppieters
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Leuven, KUL, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Sinnaeve
authors.affiliation: Cardiology Department, Universitair Ziekenhuis Antwerpen, UA, Belgium.
authors.forename: M J
authors.initials: MJ
authors.lastname: Claeys
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects; D000397:Air Pollution / Q000009:adverse effects*; D001530:Belgium / Q000453:epidemiology; D018592:Cross-Over Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000009:adverse effects; D011446:Prospective Studies; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: Air pollution; Case-crossover; Myocardial infarction; NO(2); Particle; STEMI