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Air temperature effect on acute myocardial infarction incidence : a study in the temperate climate of Almada, Portugal
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Autores
Orientador(es)
Resumo(s)
Contexto
A literatura tem vindo a associar a temperatura atmosférica à incidência de enfarte agudo do miocárdio (EAM). Que nós tenhamos conhecimento, este representa o primeiro estudo realizado num clima mediterrânico que tenta encontrar uma associação entre ambos o enfarte com supra-desnivelamento do segmento ST (STEMI) e sem supra-desnivelamento do segmento ST (NSTEMI) e a temperatura atmosférica.
Métodos
Um estudo de coorte retrospetivo foi conduzido entre 1 de janeiro de 2017 e 31 de dezembro de 2021 em Almada (Portugal) numa região com um clima mediterrânico temperado caracterizado por verões muito quentes e invernos pouco frios. Dados diários da temperatura atmosférica vieram de uma única estação de um instituto associado ao governo. Foram selecionados todos os doentes consecutivos de uma base de dados associada à angiografia do hospital e desses foram incluídos aqueles que foram encaminhados para fazer angiografia coronária com suspeita de EAM. As datas do início dos sintomas foram registadas em todos os doentes e combinadas com os dados da temperatura diária para essas datas. A análise foi feita utilizando modelos de regressão de Poisson.
Resultados
A população em estudo foi composta por 1880 doentes (65,9% homens) com uma média (DP) de idade de 65,4 (13,3) anos. Doentes com NSTEMI (941) foram mais velhos que os que tiveram STEMI (67,3 vs. 63,6-; p<0.01) e tinham maior prevalência de diabetes, hipertensão e dislipidemia, mas menor prevalência de tabagismo. A diminuição da temperatura atmosférica máxima foi associada a um aumento da incidência de EAM, com o grupo do STEMI a ter a associação mais forte (diminuição de 1 °C na temperatura atmosférica máxima levou a um aumento de 2,9% na taxa de incidência - IRR, 0,971; 95% CI, 0,957-0,986; p<.001). A associação foi significativa para ambos os subtipos de EAM ao longo das análises para os dias anteriores aos eventos e especialmente na estação do Outono.
Conclusões
A associação entre a diminuição da temperatura e o EAM foi consistente ao longo dos subgrupos, para ambos o STEMI e NSTEMI, e também nas análises para os dias anteriores aos eventos.
Background Previous literature has linked ambient temperature with myocardial infarction (MI) incidence. To our knowledge, this is the first study in a Mediterranean climate seeking an association of both ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) and air temperature. Methods A retrospective cohort study was conducted from January 1 of 2017 to December 31 of 2021 in Almada (Portugal) in a region with a Mediterranean temperate climate characterized by hot summers and mild winters. Daily data on air temperature came from a single station from a government-led institute. Consecutive patients were selected from a hospital coronary angiography database and included all patients referred for coronary angiography with suspected MI. The date of symptom onset was recorded for every patient and merged with the data on daily air temperature. Analysis was done using Poisson regression models. Results The study population comprised 1880 patients (65,9% men) with a mean (SD) of 65,4 (13,3) years. NSTEMI patients (941) were older than the STEMI ones (67,3 vs. 63,6-; p<0.01) and had more diabetes, hypertension, and dyslipidemia but had less active smokers. Decreasing maximum air temperature was associated with an increase in MI incidence, with the STEMI group having the strongest association (1 °C decrease in maximum air temperature leading to a 2,9% increase in incidence rate - IRR, 0,971; 95% CI, 0,957-0,986; p<<.001). The association was significant for both subtypes of MI across the lagged analysis and in the fall season. Conclusions The association between a decrease in temperature and MI was consistent through subgroups, both in STEMI and NSTEMI and also on lagged analysis.
Background Previous literature has linked ambient temperature with myocardial infarction (MI) incidence. To our knowledge, this is the first study in a Mediterranean climate seeking an association of both ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) and air temperature. Methods A retrospective cohort study was conducted from January 1 of 2017 to December 31 of 2021 in Almada (Portugal) in a region with a Mediterranean temperate climate characterized by hot summers and mild winters. Daily data on air temperature came from a single station from a government-led institute. Consecutive patients were selected from a hospital coronary angiography database and included all patients referred for coronary angiography with suspected MI. The date of symptom onset was recorded for every patient and merged with the data on daily air temperature. Analysis was done using Poisson regression models. Results The study population comprised 1880 patients (65,9% men) with a mean (SD) of 65,4 (13,3) years. NSTEMI patients (941) were older than the STEMI ones (67,3 vs. 63,6-; p<0.01) and had more diabetes, hypertension, and dyslipidemia but had less active smokers. Decreasing maximum air temperature was associated with an increase in MI incidence, with the STEMI group having the strongest association (1 °C decrease in maximum air temperature leading to a 2,9% increase in incidence rate - IRR, 0,971; 95% CI, 0,957-0,986; p<<.001). The association was significant for both subtypes of MI across the lagged analysis and in the fall season. Conclusions The association between a decrease in temperature and MI was consistent through subgroups, both in STEMI and NSTEMI and also on lagged analysis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Enfarte agudo do miocárdio Non-ST Elevated Myocardial Infarctio (NSTEMI) ST Elevation Myocardial Infarction (STEMI) Incidência Temperatura atmosférica Clima temperado mediterrânico Cardiologia