Correlations Between Air Pollutants and Acute Coronary Syndrome Subtypes: A 6 Year Analysis

Objective: Air pollution is a major global public health concern and has been increasingly linked to cardiovascular diseases, including acute coronary syndrome (ACS). This study investigated the temporal association between air pollution and the case counts of ACS in ***, northern Türkiye.
Method: In this retrospective study, the medical records of 6185 ACS patients at a single hospital, including cases of ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris were analyzed. Environmental air pollutants (e.g., PM10, PM2.5, NO, NOx) levels were collected and their temporal correlations with the case counts of ACS were determined. Seasonal variations in both the number of hospital admissions of ACS cases and pollutant concentrations were also evaluated.
Results: Seasonal analysis revealed a significantly higher number of hospital admissions for acute coronary syndrome during winter compared with other seasons in this single-center study conducted in northern Türkiye (p<0.05). The levels of particulate matter (PM10 and PM2.5) were also elevated in winter, with PM2.5 showing a moderate positive correlation with the case counts of STEMI (r=0.38, p=0.0005) and a strong positive correlation with NSTEMI (r=0.55, p<0.0001). Nitrogen oxides (NO and NOx) exhibited elevations in winter but did not show significant correlations with overall ACS case counts.
Conclusion: Targeted public health strategies are required to mitigate pollution exposure, particularly during high-risk seasons. Further research with more accurate and higher-resolution pollution metrics and longitudinal data is warranted to deepen our understanding of the cardiovascular impacts of specific pollutants and to develop effective intervention strategies.

Keywords: Acute coronary syndrome, air pollution, particulate matter, seasonal variation