Impact of Short-Term Air Pollution Exposure on Acute Coronary Syndrome in Two Cohorts of Industrial and Non-Industrial Areas: A Time Series Regression with 6,000,000 Person-Years of Follow-Up (ACS - Air Pollution Study)

Background: There is a lack of data on the effect of air pollution on acute coronary syndrome (ACS) in industrial and non-industrial areas. Objectives: A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas. Materials and Methods: The study covered 6,000,000 person-years of follow-up and five types of air pollution between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS. Results: The daily concentrations of PM2.5, PM10, NO2, SO2, CO were higher in industrial than in non-industrial area(P<0.001). In non-industrial area, an increase of 10 µg/m3 of NO2 concentration (Relative Risk (RR)=1.126, 95%CI=1.009–1.257;P=0.034, lag-0) and an increase of 1 mg/m3 in CO concentration (RR=1.055, 95%CI=1.010–1.103;P=0.017, lag-0) were associated with an increase in the number of hospitalization due to Non-ST segment elevation myocardial infarction (NSTEMI) (for industrial area increase of 10 µg/m3 in NO2 (RR=1.062, 95%CI=1.020–1.094;P=0.005, lag-0), SO2 (RR=1.061, 95%CI=1.010–1.116;P=0.018, lag-4), PM10 (RR=1.010, 95%CI=1.001–1.030;P=0.047, lag-6). In ST-segment elevation myocardial infarction (STEMI) patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 µg/m3 in SO2 (RR=1.094, 95%CI=1.030–1.162;P=0.002, lag-1), PM2.5 (RR=1.041, 95%CI=1.020–1.073;P<0.001, lag-1), PM10 (RR=1.030, 95%CI=1.010–1.051;P<0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area. Conclusion: The effect of NO2 on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO2 on NSTEMI and STEMI were also observed. A negative clinical effect was more delayed in patients with NSTEMI, especially after exposure to PM10 . Chronic exposure to air pollution causes destabilization of atheroscleroticplaque and may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI. Trial Registration: This study was registered at ClinicalTrials.gov (NCT04539925). Funding Statement: No external funding. Declaration of Interests: Not declared. Ethics Approval Statement: The study was approved by the bioethics committee of the Medical University of Bialystok (Approval No.: R-1-002/18/2019).