Association between ambient particulate matter air pollution and ST-elevation myocardial infarction: A case-crossover study in a Chinese city

Chemosphere. 2019 Mar;219:724-729. doi: 10.1016/j.chemosphere.2018.12.094. Epub 2018 Dec 12.


Background: Abundant epidemiological studies have revealed that short-term exposure to ambient air pollution increased the incidence of ischemic heart diseases. However, few investigations have explored the association between air pollution and ST-elevation myocardial infarction (STEMI), one major subtype of such events.

Methods: We conducted a time-stratified case-crossover study in two major hospitals of Yancheng, a city in East China, from January 2015 to February 2018. We used conditional logistic regression models to explore the association between hourly concentrations of air pollutants and STEMI hospitalizations. We explored potential effect modification in susceptible subgroups by age, gender, smoking status, and comorbidities. Two-pollutant models were fitted to test the robustness of the association.

Results: We identified a total of 347 STEMI patients. In single-pollutant models, each 10 μg/m3 increase in concentrations of fine and inhalable particulate matter (PM) (lag 13-24 h) was associated with increments of 5.27% [95% confidence interval (CI): 1.09%, 9.46%] and 3.86% (95%CI: 0.83%, 6.88%) in STEMI hospitalizations, respectively. We observed slightly larger associations of STEMI hospitalization with PM in patients who were older than 65, female, non-smoker, and with comorbidities (hypertension, diabetes or hyperlipidemia). The associations were generally robust to adjustment of criteria gaseous pollutants except for carbon monoxide.

Conclusion: This is the first study in China that suggested acute exposure to elevated PM concentrations may trigger STEMI. Patients with cardiometabolic comorbidities were slightly more susceptible to air pollution.

Keywords: Air pollution; Case-crossover study; Particulate matter; ST-elevation myocardial infarction.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Air Pollution / analysis
  • China / epidemiology
  • Cities
  • Cross-Over Studies
  • Female
  • Hospitalization
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis*
  • ST Elevation Myocardial Infarction / etiology*


  • Particulate Matter