China Chest Pain Center data highlights heightened air pollution susceptibility in MINOCA patients
Ischemic heart disease stands as a leading global cause of premature mortality. Acute myocardial infarction, the most critical clinical manifestation and the most common fatal presentation of ischemic heart disease, has been established in numerous studies to be associated with particulate air pollution. Based on whether the coronary lumen area stenosis is ≥50%, acute myocardial infarction can be classified into MI-CAD and MINOCA. Because the pathogenesis and pathophysiological process of MINOCA are essentially different from MI-CAD, the secondary prevention strategy of acute myocardial infarction, which is mainly based on the evidence of patients with MI-CAD, has limited effect in patients with MINOCA. Therefore, it is of great significance to clarify the different effects of environmental air pollution on the incidence of MINOCA and MI-CAD to promote the accurate prevention and treatment of acute myocardial infarction.
The Chest Pain Center Database of the China Cardiovascular Health Alliance was established in 2015. It is the most nationally representative multicenter disease registry in the cardiovascular field. In this study, the registration data from January 1, 2015, to December 31, 2021, were extracted from the database, and an individual-level case crossover study was carried out. After excluding standard screening and classification, the study finally included 918,730 patients with MI-CAD and 83,802 patients with MINOCA. The researchers obtained the hourly concentrations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), and other air pollutants from the national urban air quality real-time release platform and matched the high-resolution reanalysis temperature and humidity data of ERA5 provided by the European Centre for Medium-Range Weather Forecasts. The conditional logistic regression model and polynomial distribution lag model (PDLM) were used to control the temperature, humidity, and holidays in the model, respectively, to explore the relationship between PM2.5/PM10 hour exposure and the onset of MI-CAD/MINOCA and the time lag model to further calculate the disease burden of MI-CAD/MINOCA caused by atmospheric particles. In addition, in order to explore the influence of different population characteristics on the research results, the researchers further conducted a hierarchical analysis according to the age, gender, residence address, and onset season of the patients. Their findings were made available online in the Chinese Medical Journal on May 19, 2026.
Figure 1 depicts the lag-response curves for acute onset of MINOCA and MI-CAD triggered by short-term exposure to PM2.5 and PM10. The results demonstrate that the effects of PM2.5 and PM10 on the onset of both MINOCA and MI-CAD emerged rapidly after exposure, gradually attenuated thereafter, and lost statistical significance after 25 to 30 hours.
Figure 2. Cumulative exposure-response curves for acute onset of MINOCA and MI-CAD following 0-72 hour lagged short-term exposure to PM2.5 and PM10. The exposure-response relationships demonstrated approximately linear patterns without apparent thresholds. Increasing concentrations of PM2.5 and PM10 were associated with progressively elevated risks of both MINOCA and MI-CAD onset, with MINOCA exhibiting steeper curves and higher risk estimates.
The study found that the attributable fractions of acute MINOCA onset due to short-term exposure to PM2.5 and PM10 were 2.43% and 1.72%, respectively, approximately 1-2 times greater than those for acute MI-CAD onset (1.27% and 0.54%, respectively).
Based on the national chest pain center database, this individual-level case-crossover study demonstrated that MINOCA exhibits greater susceptibility to air pollution compared with MI-CAD. Our findings further reveal a novel hourly lag pattern of air pollution effects, indicating that even at concentrations meeting health-based air quality standards, short-term particulate matter exposure can produce immediate impacts. These results may provide important implications for the prevention and clinical management of acute myocardial infarction.
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Reference
DOI: 10.1097/CM9.0000000000004088
About Assistant Dean Jing Yang from the Fudan University
Chief physician, postgraduate tutor, assistant dean of Xuhui Hospital, Zhongshan Hospital affiliated to Fudan University, and director of cardiology. Member of Cardiovascular Branch of Chinese Medical Association, Member of Cardiovascular Physician Branch of Chinese Medical Association, Vice Chairman of Youth Committee of Cardiovascular Branch of Shanghai Medical Association, Standing Committee of Cardiac Rehabilitation Management Committee of China Hospital Association, Standing Committee of Cardiovascular Medicine Research Committee of China association of traditional Chinese Medicine, Deputy Secretary-General of Pan-vascular Medicine Committee, and expert in certification and quality control of chest pain center. Long-term commitment to atherosclerotic diseases, artificial intelligence big data, the establishment and transformation of pan-vascular disease prevention and control and management system research. He has presided over projects such as National Natural Science Foundation, National Key R&D Plan and Postdoctoral Fund.
About Dr. Jia Huang from Fudan University
Attending physician, Ph.D., Department of Cardiology, Zhongshan Hospital affiliated to Fudan University. Mainly engaged in the direction of coronary heart disease intervention, long-term commitment to the basic and clinical research of hypertrophic cardiomyopathy and ischemic cardiomyopathy. He is in charge of the National Natural Science Foundation (Youth and General Program) and the Shanghai Innovative Medical Machinery Application Demonstration Project. Published 9 research papers in internationally renowned magazines such as European heart journal and Hypertension. Authorized 1 invention patent and 2 utility model patents. He was selected into the john young Talent Plan of Shanghai Youth Science and Technology and won the second prize of Jiangsu Science and Technology Progress in 2024.
About Professor Yuxiang Dai from Fudan University
Professor, Chief Physician, Doctoral Supervisor, Deputy Director of Cardiology Department of Zhongshan Hospital affiliated to Fudan University, Fellow of European Cardiology Society, Fellow of American Cardiology Society; He also serves as the Youth Committee of Cardiovascular Branch of Chinese Medical Association, deputy head of the Youth Group of Rare Diseases Branch of Chinese Medical Association, vice chairman of the Youth Committee of Cardiovascular Branch of Shanghai Medical Association, member of the Coronary Heart Disease Group of Cardiovascular Physicians Branch of Chinese Medical Association, member of the Clinical Prevention Branch of Chinese Preventive Medical Association, vice chairman of the Committee on Cardiac Severe Diseases of Cross-Strait Medical and Health Exchange Association, vice chairman of the Committee on Severe Metabolic Diseases of China National Health Association, member of the Cardiovascular Committee of China Pathophysiology Association and member of the Committee on Bioactive Small Molecules of China Pathophysiology Association. Long-term commitment to the whole chain mechanism and transformation of ischemic heart disease. Presided over key projects of the National Fund Committee and major national special projects. He has published more than 50 research papers in internationally renowned magazines such as Circulation, Eur Heart J, Cell Genomics, etc., with an H index of 18 and a total of more than 1,000 SCI citations. As the first inventor, he granted 6 patents; Selected as outstanding academic leaders in Shanghai and Shanghai Oriental Talents Program.
Funding information
This work was supported by the National Key Research and Development Project of China (Nos. 2021YFC2500500 and 2022YFC3702701), Shanghai Committee of Science and Technology (No. 21TQ015), Program of Shanghai Academic Research Leader (No. 22XD1423300), the State Key Clinical Specialty Construction Project (No. YW2021-002), Shanghai Clinical Research Center for Interventional Medicine (No. 19MC1910300), Shanghai Municipal Key Clinical Specialty (No. shslczdzk01701), and National Natural Science Foundation of China (Nos. 81900217, 82370357, and 82470360).
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