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Zhang W, Zhu A, Ling J, Zhang R, Liu T, Tian T, Niu J, Dong J, Ruan Y. Short-term effects of nitrogen dioxide on inpatient acute myocardial infarction in Lanzhou, China. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2024; 74:449-456. [PMID: 38739852 DOI: 10.1080/10962247.2024.2350441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Nitrogen dioxide (NO2) represents a deleterious effect on acute myocardial infarction (AMI), but few relevant studies have been conducted in China. We aim to evaluate the acute effects of NO2 exposure on hospitalization for AMI in Lanzhou, China. In this study, we applied a distributional lag nonlinear model (DLNM) to assess the association between NO2 exposure and AMI hospitalization. We explored the sensitivity of various groups through stratified analysis by gender, age, and season. The daily average concentration of NO2 is 47.50 ± 17.38 µg/m3. We observed a significant exposure-response relationship between NO2 concentration and AMI hospitalization. The single pollutant model analysis shows that NO2 is positively correlated with AMI hospitalization at lag1, lag01, lag02, and lag03. The greatest lag effect estimate occurs at lag01, where a 10 µg/m3 increase in NO2 concentrations is significantly associated with a relative risk (RR) of hospitalization due to AMI of 1.027 [95% confidence interval (CI): 1.013, 1.042]. The results of the stratified analysis by gender, age, and season indicate that males, those aged ≥65 years, and the cold season are more sensitive to the deleterious effects caused by NO2 exposure. Short-term exposure to NO2 can enhance the risk of AMI hospitalization in urban Lanzhou.Implications: Exposure to particulate matter can lead to an increased incidence of AMI. Our study once again shows that NO2 exposure increases the risk of AMI hospital admission. AMI is a common and expensive fatal condition. Reducing NO2 exposure will benefit cardiovascular health and save on healthcare costs.
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Affiliation(s)
- Wancheng Zhang
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Anning Zhu
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Jianglong Ling
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Runping Zhang
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Tong Liu
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Tian Tian
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Jingping Niu
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Ye Ruan
- School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
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Zhang J, Xu H, Yao M, Jia H, Cong H. The abnormal level and prognostic potency of multiple inflammatory cytokines in PCI-treated STEMI patients. J Clin Lab Anal 2022; 36:e24730. [PMID: 36245413 DOI: 10.1002/jcla.24730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Inflammatory cytokines modulate atherogenesis and plaque rupture to involve in ST-segment elevation myocardial infarction (STEMI) progression. The present study determined eight inflammatory cytokine levels in 212 percutaneous coronary intervention (PCI)-treated STEMI patients, aiming to comprehensively investigate their potency in estimating major adverse cardiac event (MACE) risk. METHODS Serum tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17A, vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1) of 212 PCI-treated STEMI patients and 30 angina pectoris patients were determined using enzyme-linked immunosorbent assay. RESULTS TNF-α (52.5 (43.9-62.6) pg/ml versus 46.4 (39.0-59.1) pg/ml, p = 0.031), IL-8 (61.6 (49.6-81.7) pg/ml versus 46.7 (32.5-63.1) pg/ml, p = 0.001), IL-17A (57.4 (45.7-77.3) pg/ml versus 43.2 (34.2-64.6) pg/ml, p = 0.001), and VCAM-1 (593.6 (503.4-811.4) ng/ml versus 493.8 (390.3-653.7) ng/ml, p = 0.004) levels were elevated in STEMI patients compared to angina pectoris patients, while IL-1β (p = 0.069), IL-6 (p = 0.110), IL-10 (p = 0.052), and ICAM-1 (p = 0.069) were of no difference. Moreover, both IL-17A high (vs. low) (p = 0.026) and VCAM-1 high (vs. low) (p = 0.012) were linked with increased cumulative MACE rate. The multivariable Cox's analysis exhibited that IL-17A high (vs. low) (p = 0.034) and VCAM-1 high (vs. low) (p = 0.014) were independently associated with increased cumulative MACE risk. Additionally, age, diabetes mellitus, C-reactive protein, multivessel disease, stent length, and stent type were also independent factors for cumulative MACE risk. CONCLUSION IL-17A and VCAM-1 high level independently correlate with elevated MACE risk in STEMI patients, implying its potency in identifying patients with poor prognoses.
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Affiliation(s)
- Jing Zhang
- Department of Cardiology, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China
| | - Huichuan Xu
- Department of Cardiology, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Mingyan Yao
- Department of Endocrinology, Baoding No.1 Central Hospital, Baoding, China
| | - Hongdan Jia
- Department of Cardiology, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Hongliang Cong
- Department of Cardiology, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
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Li S, Gao X, Yang J, Xu H, Wang Y, Zhao Y, Yin L, Wu C, Wang Y, Zheng Y, Li B, Zhang X, Ye Y, Fu R, Dong Q, Sun H, Yan X, Wu Y, Zhang J, Jin C, Li W, Yang Y. Number of standard modifiable risk factors and mortality in patients with first-presentation ST-segment elevation myocardial infarction: insights from China Acute Myocardial Infarction registry. BMC Med 2022; 20:217. [PMID: 35790971 PMCID: PMC9258075 DOI: 10.1186/s12916-022-02418-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent publications reported a paradoxical finding that there was an inverse association between the number of standard modifiable risk factors (SMuRFs; smoking, hypertension, diabetes, and hyperlipidemia) and mortality in patients with myocardial infarction. However, the current evidence is only limited to those highly developed countries with advanced medical management systems. METHODS The China Acute Myocardial Infarction registry is a prospective observational study including patients with acute myocardial infarction from three-level hospitals across 31 administrative regions throughout mainland China. A total of 16,228 patients with first-presentation ST-elevation myocardial infarction (STEMI) admitted to hospitals from January 2013 to September 2014 were enrolled in the current analysis. Cox proportional hazard models adjusting for baseline characteristics, clinical profiles at presentation, and in-hospital treatments were used to assess the association of the number of SMuRFs with all-cause mortality at 30 days after STEMI presentation. RESULTS A total of 1918 (11.8%), 11,503 (70.9%), and 2807 (17.3%) patients had 0, 1-2, and 3-4 SMuRFs at presentation, respectively. Patients with fewer SMuRFs were older and more likely to be females, experienced longer pre-hospital delays, and were less likely to receive primary percutaneous coronary intervention and evidence-based medications. Compared with those without any SMuRF, patients with 1-2 SMuRFs and 3-4 SMuRFs were associated with an HR of 0.74 (95% CI, 0.63-0.87) and 0.63 (0.51-0.77) for all-cause mortality up to 30 days in the unadjusted model (Ptrend < 0.0001). However, after multivariate adjustment, the number of SMuRFs was positively associated with increased mortality risk (HR for 1-2 SMuRFs, 1.15 [0.95-1.39]; HR for 3-4 SMuRFs, 1.31 [1.02-1.68]; Ptrend = 0.03), and the association was only significant among patients admitted to hospitals beyond 12 h from onset (HR for 1-2 SMuRFs, 1.39 [1.03-1.87]; HR for 3-4 SMuRFs, 2.06 [1.41-3.01]) but not their counterparts (Pinteraction = 0.01). CONCLUSIONS The increased crude mortality risk among patients without SMuRFs is explained by confounding factors related to their poor risk profiles (old age, longer pre-hospital delays, and poor clinical management). After multivariate adjustment, a higher risk-factor burden was associated with poor prognosis among patients with STEMI.
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Affiliation(s)
- Sidong Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 102300, China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China.
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Yang Wang
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 102300, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 102300, China
| | - Lu Yin
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 102300, China
| | - Chao Wu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Yi Wang
- Xiamen Cardiovascular Hospital, Xiamen, Fujian, China
| | - Yang Zheng
- The First Hospital of Jilin University, Jilin, China
| | - Bao Li
- The Affiliated Cardiovascular Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuan Zhang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Yunqing Ye
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Rui Fu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Qiuting Dong
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Hui Sun
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Xinxin Yan
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Yuan Wu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Jun Zhang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Chen Jin
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Wei Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 102300, China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China.
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Yao W, Li J. Risk factors and prediction nomogram model for 1-year readmission for major adverse cardiovascular events in patients with STEMI after PCI. Clin Appl Thromb Hemost 2022; 28:10760296221137847. [PMID: 36380508 PMCID: PMC9676288 DOI: 10.1177/10760296221137847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 04/13/2024] Open
Abstract
To identify risk factors and develop a risk-prediction nomogram model for 1-year readmission due to major adverse cardiovascular events (MACEs) in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). This was a single-center, retrospective cohort study. A total of 526 eligible participants were enrolled, which included 456 non-readmitted and 70 readmitted patients. Multivariate logistical regressions were performed to identify the independent risk factors for readmission, and a prediction nomogram model was developed based on the results of the regression analysis. The receiver operating characteristic curve, Hosmer-Lemeshow test, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Female (OR = 2.426; 95% CI: 1.395-4.218), hypertension (OR = 1.898; 95% CI: 1.100-3.275), 3-vessel disease (OR = 2.632; 95% CI: 1.332-5.201), in-hospital Ventricular arrhythmias (VA) (OR = 3.143; 95% CI: 1.305-7.574), peak cTnI (OR = 1.003; 95% CI: 1.001-1.004) and baseline NT-proBNP (OR = 1.001; 95% CI: 1.000-1.002) were independent risk factors for readmission (all P < 0.05). The nomogram exhibited good discrimination with the area under the curve (AUC) of 0.723, calibration (Hosmer-Lemeshow test; χ2 = 15.396, P = 0.052), and clinical usefulness. Female gender, hypertension, in-hospital VA, 3-vessel disease, baseline NT-proBNP, and peak cTnI were independent risk factors for readmission. The nomogram helped clinicians to identify the patients at risk of readmission before their hospital discharge, which may help reduce readmission rates.
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Affiliation(s)
- Wensen Yao
- Department of Cadre's Ward, The First Hospital of Jilin University, Changchun, China
| | - Jie Li
- Department of Cadre's Ward, The First Hospital of Jilin University, Changchun, China
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