Eur Heart J：空气污染与急性冠脉综合症患者存活率有关

大量研究表明长期暴露于空气污染环境，特别是不溶性微粒，与心血管疾病发病有关。心肌缺血患者可能对空气污染更敏感。近期，伦敦卫生和热带医学学校的开展了相关研究，目的是应用英格兰和威尔士心肌缺血国家审计项目的相关资料明确心肌缺血患者所有病因导致的死亡率是否与长期暴露于空气污染环境有关，并进一步阐明空气污染暴露的程度对患者预后社会经济不平等的影响。结果显示，空气污染对心脏病患者所有原因导致的死亡率有影响。

国家心血管研究成果研究所收集的心肌缺血国家审计项目中因急性冠脉综合征入院患者的相关记录与模式2004-2010年年度平均空气污染浓度建立联系。应用Cox比例风险模型评估入院后28天开始的死亡率风险比。在同组的154205名患者中，平均随访时间为3.7年，其中有39863名患者死亡。暴露于直径小于等于2.5μm不溶性微粒较高水平的患者死亡率很高（PM2.5；PM，不溶性微粒）：PM2.5的环境下，10μg/m3完全校正风险比为1.20（95%可信区间1.04-1.38）。本研究没有观察较大微粒或氮氧化物与死亡率的关系。空气污染对幸存患者社会经济不平等性影响程度很少。

结论如下，在英格兰和威尔士，因急性冠脉综合征入院的幸村患者暴露于PM2.5的空气污染环境时，所有原因导致的死亡率明显升高。尽管贫困地区人群死亡率很高，但对急性冠脉综合症患者预后的社会经济不平等性影响很少。本研究为阐明长期暴露于微粒与患者死亡率的关系提供了实验证据。

Long-term exposure to air pollution is associated with survival following acute coronary syndrome.
AIMS
The aim of this study was to determine (i) whether long-term exposure to air pollution was associated with all-cause mortality using the Myocardial Ischaemia National Audit Project (MINAP) data for England and Wales, and (ii) the extent to which exposure to air pollution contributed to socioeconomic inequalities in prognosis.
METHODS AND RESULTS
Records of patients admitted to hospital with acute coronary syndrome (ACS) in MINAP collected under the National Institute for Cardiovascular Outcomes Research were linked to modelled annual average air pollution concentrations for 2004-10. Hazard ratios for mortality starting 28 days after admission were estimated using Cox proportional hazards models. Among the 154 204 patients included in the cohort, the average follow-up was 3.7 years and there were 39 863 deaths. Mortality rates were higher for individuals exposed to higher levels of particles with a diameter of ≤2.5 µm (PM2.5; PM, particulate matter): the fully adjusted hazard ratio for a 10 µg/m(3) increase in PM2.5 was 1.20 (95% CI 1.04-1.38). No associations were observed for larger particles or oxides of nitrogen. Air pollution explained socioeconomic inequalities in survival to only a small extent.
CONCLUSION
Mortality from all causes was higher among individuals with greater exposure to PM2.5 in survivors of hospital admission for ACS in England and Wales. Despite higher exposure to PM2.5 among those from more deprived areas, such exposure was a minor contribution to the socioeconomic inequalities in prognosis following ACS. Our findings add to the evidence of mortality associated with long-term exposure to fine particles.