{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:24Z","timestamp":1792785864402,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Fonds Joseph Oscar Waldmann-Berteau of the King Baudouin Foundation","id":[{"id":"https:\/\/ror.org\/02am44w88","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Belgian Heart League"},{"name":"Department of Care of the Flemish Government","id":[{"id":"https:\/\/ror.org\/04qxsrb28","id-type":"ROR","asserted-by":"crossref"}]},{"name":"European Union\u2019s Horizon Europe Health 2024 programme","award":["101157151"],"award-info":[{"award-number":["101157151"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Current risk models for myocardial infarction incidence and post-event mortality primarily rely on clinical parameters and do not account for environmental or socioeconomic factors. We aimed to provide a more comprehensive assessment of determinants of ST-elevation myocardial infarction (STEMI) admission and in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed 9 years of national hospital discharge data of all STEMI admissions in Belgium (2012\u201314, 2016\u201321). Acute and chronic exposures to PM2.5, NO2, O3, temperature, noise, and green space were estimated at residential addresses using high-resolution models. Individual socioeconomic data were linked from administrative records. A time-stratified case-crossover design assessed associations between short-term air pollution exposures and STEMI admission, including delayed associations. Multivariable logistic regression examined clinical, socioeconomic, and environmental determinants of in-hospital mortality. A total of 51 544 STEMI admissions were identified (51.3 per 100 000 inhabitants\/year). Interquartile range increases in PM2.5 and NO2 were associated with higher same-day STEMI admission risk (PM2.5: OR 1.022, 95%CI 1.008\u20131.035; NO2: OR 1.044, 95% CI 1.025\u20131.063). O3 showed associations over delayed exposure windows (strongest at lag 0\u20132: OR 1.063, 95% CI 1.034\u20131.090). In-hospital mortality was 11.8% and was most strongly associated with socioeconomic factors, including lower individual and area-level income and retirement status, alongside clinical characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Environmental factors through air pollution are associated with STEMI incidence, whereas socioeconomic factors such as financial precarity are related to in-hospital mortality. New risk models integrating socioeconomic and environmental vulnerabilities are needed to ensure early recognition and reinforced care for patients at risk of adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag118","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:20:38Z","timestamp":1788348038000},"source":"Crossref","is-referenced-by-count":0,"title":["Influences of socioeconomic and environmental factors on STEMI incidence and related mortality: insights from the Belgian Environmental Myocardial Infarction Risk (EMIR) Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9717-3917","authenticated-orcid":false,"given":"Tom","family":"De Potter","sequence":"first","affiliation":[{"name":"Department of Cardiology, Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Laarbeeklaan 101, 1090 Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christel","family":"Faes","sequence":"additional","affiliation":[{"name":"I-BioStat, Data Science Institute, Hasselt University , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Motoc","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Laarbeeklaan 101, 1090 Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Els","family":"Verachtert","sequence":"additional","affiliation":[{"name":"Environmental Intelligence Unit, Flemish Institute for Technological Research (VITO) , Mol ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Cox","sequence":"additional","affiliation":[{"name":"VITO Health, Flemish Institute for Technological Research (VITO) , Mol ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6166-341X","authenticated-orcid":false,"given":"Hans","family":"Hooyberghs","sequence":"additional","affiliation":[{"name":"Environmental Intelligence Unit, Flemish Institute for Technological Research (VITO) , Mol ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Deligiannis","sequence":"additional","affiliation":[{"name":"Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Rodrigo Bonet","sequence":"additional","affiliation":[{"name":"Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik","family":"De Cock","sequence":"additional","affiliation":[{"name":"Biostatistics and Medical Informatics Research Group, Department of Public Health, Vrije Universiteit Brussel , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans","family":"Fierens","sequence":"additional","affiliation":[{"name":"Belgian Interregional Environment Agency , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3583-3593","authenticated-orcid":false,"given":"Tim","family":"Nawrot","sequence":"additional","affiliation":[{"name":"Centre for Environmental Sciences, Hasselt University , Hasselt ,","place":["Belgium"]},{"name":"Environment & Health, Department of Public Health and Primary Care, University of Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-3249","authenticated-orcid":false,"given":"Steven","family":"Droogmans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Laarbeeklaan 101, 1090 Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Cosyns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Laarbeeklaan 101, 1090 Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6628-9543","authenticated-orcid":false,"given":"Marc J","family":"Claeys","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Antwerp University Hospital , Edegem ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Argacha","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Laarbeeklaan 101, 1090 Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"2026100806320178000_zuag118-B1","first-page":"e596","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice 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