Triggering of ST-Elevation Myocardial Infarction by Particulate Air Pollution Concentrations in Monroe County, New York: Before, During, and After Multiple Air Quality Interventions and Policies - The Rochester Accountability Study

Previously, we reported that increased PM concentrations triggered ST elevation myocardial infarction (STEMI), with the largest rate of MI when pollutant mixtures were high in secondary particles. From 2007-2013, several policies were implemented to improve air quality and reduce pollutant emissions nationally and in New York (NY). In Rochester, NY, concentrations of submicron particles, SO2, and PM2.5 and its main component (SO42-, NO3-, elemental and primary organic carbon) were substantially lower AFTER these policies were implemented (2014-2016) than BEFORE (2005-2007) and DURING policy implementation (2008-2013). However, secondary organic carbon (SOC) concentrations increased AFTER implementation. Using 921 STEMIs treated at the University of Rochester Medical Center Cardiac Catheterization Laboratory and case-crossover methods, we examined whether the rate of STEMI associated with increased PM2.5, ultrafine particles (UFP, <100nm), accumulation mode particles (100-500nm), black carbon (BC), SO2, CO, and O3, in the previous 1-72 hours, was modified by period (BEFORE, DURING, AFTER), to evaluate whether pollutant compositional changes affected the relative rate of acute cardiovascular events. Interquartile range increases in UFP concentration in the previous 1 and 3 hours were associated with 12% (95% CI = 3%, 22%) and 11% (95% CI = 2%, 22%) increases, respectively, in the rate of STEMI, with similar patterns for BC, CO, and SO2. However, each 3702 particles/cm3 increase in UFP in the previous hour was associated with a larger increased rate of STEMI in the AFTER period (26%; 95% CI=7%, 48%) than the DURING (5%; 95% CI=-12%, 24%) or BEFORE periods (9%; 95% CI=-4%, 23%). There were similar BC and SO2 patterns. Given the concomitant changes in PM composition, strong oxidants associated with SOC particles and their ability to induce additional oxidative stress may be particularly important with regard to the triggering of acute cardiovascular events.