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Biondi-Zoccai G, Rodriguez-Granillo GA, Mercade JM, Dawidowski L, Seropian IM, Cohen F, Sturmer-Ramos C, Descalzo A, Rubilar B, Sztejfman M, Zaidel E, Pazos C, Leguizamon J, Cafaro G, Visconti M, Baglioni P, Noya A, Fontana L, Rodriguez-Granillo M, Pavlovsky H, Alvarez JA, Lylyk P, Versaci F, Abrutzky R. Interplay between climate, pollution and COVID-19 on ST-elevation myocardial infarction in a large metropolitan region. Minerva Med 2022; 113:950-958. [PMID: 34309338 DOI: 10.23736/s0026-4806.21.07748-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy -
| | - Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina.,National Council of Scientific and Technical Investigations, Buenos Aires, Argentina
| | - Juan M Mercade
- Agencia de Proteccion Ambiental (APRA), Buenos Aires, Argentina
| | - Laura Dawidowski
- Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina
| | - Ignacio M Seropian
- Department of Interventional Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina
| | - Fernando Cohen
- Department of Interventional Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina
| | | | - Amalia Descalzo
- Department of Interventional Cardiology ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Bibiana Rubilar
- Department of Interventional Cardiology ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Matias Sztejfman
- Department of Interventional Cardiology, Guemes Sanatorium, Buenos Aires, Argentina
| | - Ezequiel Zaidel
- Department of Interventional Cardiology, Guemes Sanatorium, Buenos Aires, Argentina
| | - Cristian Pazos
- Department of Interventional Cardiology, Santa Isabel Clinic, Buenos Aires, Argentina
| | - Jorge Leguizamon
- Department of Interventional Cardiology, Santa Isabel Clinic, Buenos Aires, Argentina
| | - German Cafaro
- Service of Interventional Cardiology, Diagnóstico Mediter-Sanatorio Dr Julio Méndez, Buenos Aires, Argentina
| | - Mariano Visconti
- Service of Interventional Cardiology, Diagnóstico Mediter-Sanatorio Dr Julio Méndez, Buenos Aires, Argentina
| | - Pablo Baglioni
- Department of Interventional Cardiology, San Juan de Dios Hospital, Buenos Aires, Argentina
| | - Agustin Noya
- Department of Interventional Cardiology, British Hospital, Buenos Aires, Argentina
| | - Lucia Fontana
- Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | | | - Hernan Pavlovsky
- Department of Interventional Cardiology, Otamendi Sanatorium, Buenos Aires, Argentina
| | - Jose A Alvarez
- Department of Interventional Cardiology, British Hospital, Buenos Aires, Argentina.,Department of Interventional Cardiology, German Hospital, Buenos Aires, Argentina
| | - Pedro Lylyk
- Department of Interventional Neuroradiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Francesco Versaci
- Unit of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Rosana Abrutzky
- University of Buenos Aires, Faculty of Social Sciences, Gino Germani Investigation Institute, Buenos Aires, Argentina
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Chashchin MG, Gorshkov AY, Strelkova AV, Drapkina OM. Features of the pathogenesis and course of myocardial infarction in COVID-19 patients: a descriptive review. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic remains one of the most urgent problems for healthcare professionals due to the variety of non-pulmonary manifestations. Along with the respiratory syndrome in a significant proportion of patients, the disease course is accompanied by pronounced systemic inflammatory response and hemostasis changes. This is associated with a high risk of complications, especially in patients with concomitant cardiovascular pathology. The aim of the study was to analyze and systematize the literature data on the pathogenesis, clinical course, and outcomes of myocardial infarction (MI) in patients with COVID-19. For review, publications indexed in the PubMed, Google Scholar, Web of Science, and Cyberleninka databases were used. The search depth was 2 years, starting from 2020. The review is based on summarized data from the most relevant clinical studies, reports and systematic reviews. The literature analysis made it possible to conclude that the published data on MI in patients with COVID-19 are currently contradictory. Multiple thrombosis, sepsis, macrophage activation, increasing hypoxemia, imbalance between myocardial oxygen supply and demand in patients with severe COVID-19 have led to a high incidence of type 1 and type 2 MI. It should be especially noted that in a number of cases, MI with COVID-19 occurs in patients with intact coronary arteries, and its course is associated with a high incidence of complications, which, in turn, leads to a significant increase in short- and mid-term mortality.
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Affiliation(s)
- M. G. Chashchin
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. Yu. Gorshkov
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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