Association Between Air Pollution and Acute Coronary Syndromes During Lockdown for COVID-19: Results From the Terni Hub Center

Abstract

Background: During the lockdown for COVID-19, a massive decrease in hospital admissions for acute coronary syndrome (ACS) and a drop in air pollution were both detected in Italy. Our aim was to investigate the possible association between these two events at the Province of Terni, one of the most polluted urban and industrial area in Central Italy.Methods: We analyzed data of daily 24-h urban air concentrations of particulate matter (PM)10 and PM2.5 from fixed station monitoring network located in the main city centers of the Terni province, and accesses for ACS at the catheterization laboratory of the Cardiological Hub Center of the Terni University Hospital during lockdown. A comparison was made with data corresponding to the same lockdown time period of years 2019, 2018, and 2017.Results: Invasive procedures for ACS decreased in 2020 (n = 49) as compared with previous years (n = 93 in 2019, n = 109 in 2018, and n = 89 in 2017, p < 0.001). Conversely, reductions in average PM10 (20.7 μg/m3) and PM2.5 (14.7 μg/m3) in 2020 were consistent with a long-term decreasing trend, being comparable to those recorded in 2019 and 2018 (all p > 0.05) and slightly lower than 2017 (p < 0.05). The Granger-causality test demonstrated the lack of association between time-varying changes in air pollution and the number of procedures for ACS.Conclusions: Our results did not support the hypothesis that reduction in invasive procedures for ACS during lockdown was linked to an air cleaning effect. Reasons other than reduced air pollution should be sought to explain the observed decrease in ACS procedures.

Fear of COVID-19 in Patients with Acute Myocardial Infarction

“…Since the symptom-onset-to-first-medical-contact time plays a crucial role in a longer delay, and patients presented with higher levels of emotional and symptomatic fear expressions than the general population, a major cause of this delayed presentation could be attributable to changes in patient behavior and risk perception, which arouses reluctance to come to the hospital for fear of contracting COVID-19, as confirmed by the patients themselves in previously published reports [ 42 , 43 ]. Interestingly, recent data have not confirmed the association between a decrease in hospital admissions for acute coronary syndrome and a decrease in air pollution due to lockdown containment measures, indirectly giving strength to other hypotheses for the drop observed in AMI procedures [ 44 ].…”

Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France

“…In addition, the concentration of most air pollutants decreased transiently during the lockdown in France, to a greater or lesser extent depending on the geographical area and its baseline pollution level [ 21 ]. But interestingly, a study specifically investigating the relation between the hospital management of ACS during the lockdown and air pollutants found no association between an short term air cleaning effect and a concomitant reduction in invasive procedures for ACS [ 22 ]. These facts raise questions about the impact of a transient and geographically heterogeneous decrease in air pollutants on the occurrence of ACS, and how it may have interacted with the other factors considered.…”

Impact of Air Pollution and COVID-19 Infection on Periprocedural Death in Patients with Acute Coronary Syndrome

“…The relationship between the incidence of ACS, periprocedural mortality resulting from this disease, and the incidence of COVID-19 has not been sufficiently reported in the literature [ 41 ]. In a relatively small Italian study evaluating the number of hemodynamic procedures in ACS in the province of Terrini in 2020—the first year of the pandemic—they found that the number of hemodynamic procedures decreased.…”