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

Abstract

Background and aims: To assess independent impacts of air and noise pollution, and residential green exposure on non-invasively derived coronary obstruction and myocardial ischemia.

Methods: Consecutive patients screened by coronary computed tomography angiography (CCTA) for stable chest pain between 01/01/2019 and 31/12/2020 were included in a registry. Exposure associations between residential PM2.5 (particulate matter <2.5 micrometres), NO2 (nitric dioxide), major road distance, airport distance and normalized difference vegetation index (NDVI), and obstructive coronary artery disease (OCAD, stenosis ≥50%) and abnormal fractional flow reserve (FFRCT<80%) measurement were assessed by propensity score-adjusted logistic regression. Subgroup analysis was performed according to Framingham low (<10%) and high (>20%) 10-year coronary heart disease risk categories.

Results: 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 and socio-economic risk factors. Distance to airport decreased OCAD risk (OR 0.983, 95%CI 0.974-0.992, per 1km) in univariable analysis. After propensity score (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 1km) in high-risk patients after PS adjustment.

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