Particulate Air Pollution as a Risk Factor for ST-Segment Depression in Patients With Coronary Artery Disease

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Abstract
Background— The association of particulate matter (PM) with cardiovascular morbidity and mortality is well documented. PM-induced ischemia is considered a potential mechanism linking PM to adverse cardiovascular outcomes. Methods and Results— In a repeated-measures study including 5979 observations on 48 patients 43 to 75 years of age, we investigated associations of ambient pollution with ST-segment level changes averaged over half-hour periods measured in the modified V5 position by 24-hour Holter ECG monitoring. Each patient was observed up to 4 times within 1 year after a percutaneous intervention for myocardial infarction, acute coronary syndrome without infarction, or stable coronary artery disease without acute coronary syndrome. Elevation in fine particles (PM2.5) and black carbon levels predicted depression of half-hour–averaged ST-segment levels. An interquartile increase in the previous 24-hour mean black carbon level was associated with a 1.50-fold increased risk of ST-segment depression ≥0.1 ...