Residential exposome and the risk of coronary obstruction and myocardial ischaemia detected by coronary computed tomography.

Abstract

Aims: To assess independent impacts of air and noise pollution and residential green exposure on non-invasively derived coronary obstruction and myocardial ischaemia.

Methods and results: Consecutive patients screened by coronary computed tomography angiography (CCTA) for stable chest pain between 1 January 2019 and 31 December 2020 were included in a registry. Exposure associations between residential PM2.5 (particulate matter <2.5 μm), NO2 (nitric dioxide), major road distance, airport distance, normalized difference vegetation index, obstructive coronary artery disease (OCAD, stenosis ≥50%), and abnormal fractional flow reserve (FFRCT ≤80%) measurements were assessed by propensity score (PS)-adjusted logistic regression. A subgroup analysis was performed according to Framingham low (<10%) and high (>20%) 10-year coronary heart disease risk categories. A total of 2620 patients were enrolled, including 420 (16%) FFRCT analyses. OCAD was reported in 518 (20%) patients and abnormal FFRCT in 276 (11%). People with OCAD lived closer to the airport [10.841 (7.869-19.022) km vs. 12.297 (8.691-22.843) km, P < 0.001). People living closer to the airport had more cardiovascular (CV) and socio-economic risk factors. Distance to airport decreased OCAD risk (OR 0.983, 95% CI 0.974-0.992, per 1 km) in univariable analysis. After PS adjustment, environmental stressors were not significantly associated with OCAD, regardless of risk categories. Only distance to major road decreased abnormal FFRCT risk (OR 0.634, 95% CI 0.421-0.926, per 1 km) in high-risk patients after PS adjustment.

Conclusion: We found no clear environmental associations with CT-derived coronary obstruction or ischaemia. However, airport proximity was linked to OCAD risk via CV and socio-economic factors, while major road proximity was independently associated with myocardial ischaemia in high-CV-risk patients, warranting further investigation.