The Possible Role of PM2.5 Chronic Exposure on 5-Year Survival in Patients with Left Ventricular Dysfunction Following Coronary Artery Bypass Grafting.
Tomasz Urbanowicz, Krzysztof Skotak, Anna Olasińska-Wiśniewska, Krzysztof J Filipiak, Aleksandra Płachta-Krasińska, Jakub Piecek, Beata Krasińska, Zbigniew Krasiński, Andrzej Tykarski, Marek Jemielity
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引用次数: 0
Abstract
Background: The survival benefit of surgical revascularization in multivessel coronary artery disease is well understood, though it can be modified by left ventricular dysfunction. Chronic exposure to air pollutants has gained more attention recently as a possible non-traditional morbidity and mortality cardiovascular risk factor. This study identified possible 5-year mortality risk factors related to postoperative left ventricular performance, including air pollutants.
Patients: There were 283 patients (244 (86%) males) with a median age of 65 (60-70) years enrolled in the retrospective analysis. All patients were referred for off-pump coronary artery revascularization due to chronic coronary syndrome that presented as a multivessel coronary artery disease. They were divided into three groups depending on the postoperative course of left ventricular fraction (LVEF 50% or more (169 patients), LVEF between 41 and 49% (61 patients), and LVEF 40% or less (53 patients)).
Results: The overall survival rate was 84% (237 patients) in a median follow-up time of 5.3 (4.8-6.1) years. The median (Q1-Q3) chronic air pollution exposures for the analyzed group were 19.3 (16.9-22.4) μg/m3 for fine particles such as PM2.5, 25.8 (22.5-29.4) μg/m3 for coarse particles such as PM10, and 12.2 (9.7-14.9) μg/m3 for nitric dioxide (NO2). The mortality in the first group (LVEF at least 50%) was 23 (13.6%), in the second group (LVEF 41-49%) was 9 (15%), and in the third group (LVEF 40% or less) was 14 (26%). The multivariable regression analysis for the five-year mortality risk in the first group revealed the predictive value of dyslipidemia (HR: 3.254, 95% CI: 1.008-10.511, p = 0.049). The multivariable regression analysis for five-year mortality risk in the second group revealed the predictive value of dyslipidemia (HR: 3.391, 95% CI: 1.001-11.874, p = 0.050) and PM2.5 (HR: 1.327, 95% CI: 1.085-1.625, p = 0.006). In the third group (severely decreased LVEF), chronic PM2.5 exposure was found to be significant (HR: 1.518, 95% CI: 1.50-2.195, p = 0.026) for 5-year mortality prediction.
Conclusions: Traditional risk factors, such as dyslipidemia, are pivotal in the 5-year mortality risk following surgical revascularization. Chronic exposure to ambient air pollutants such as PM2.5 may be an additional risk factor in patients with left ventricular dysfunction.
ToxicsChemical Engineering-Chemical Health and Safety
CiteScore
4.50
自引率
10.90%
发文量
681
审稿时长
6 weeks
期刊介绍：
The Journal accepts papers describing work that furthers our understanding of the exposure, effects, and risks of chemicals and materials in humans and the natural environment as well as approaches to assess and/or manage the toxicological and ecotoxicological risks of chemicals and materials. The journal covers a wide range of toxic substances, including metals, pesticides, pharmaceuticals, biocides, nanomaterials, and polymers such as micro- and mesoplastics. Toxics accepts papers covering:
The occurrence, transport, and fate of chemicals and materials in different systems (e.g., food, air, water, soil);
Exposure of humans and the environment to toxic chemicals and materials as well as modelling and experimental approaches for characterizing the exposure in, e.g., water, air, soil, food, and consumer products;
Uptake, metabolism, and effects of chemicals and materials in a wide range of systems including in-vitro toxicological assays, aquatic and terrestrial organisms and ecosystems, model mammalian systems, and humans;
Approaches to assess the risks of chemicals and materials to humans and the environment;
Methodologies to eliminate or reduce the exposure of humans and the environment to toxic chemicals and materials.
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