{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:36:40Z","timestamp":1790894200530,"version":"4.1.0"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,6,14]]},"abstract":"\n Background:<\/jats:title>\n Short-term exposure to ambient air pollution has been linked with daily hospitalization and mortality from acute coronary syndrome (ACS); however, the associations of subdaily (hourly) levels of criteria air pollutants with the onset of ACS and its subtypes have rarely been evaluated.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We conducted a time-stratified case-crossover study among 1\u2009292\u2009880 patients with ACS from 2239 hospitals in 318 Chinese cities between January 1, 2015, and September 30, 2020. Hourly concentrations of fine particulate matter (PM\n 2.5<\/jats:sub>\n ), coarse particulate matter (PM\n 2.5\u201310<\/jats:sub>\n ), nitrogen dioxide (NO\n 2<\/jats:sub>\n ), sulfur dioxide (SO\n 2<\/jats:sub>\n ), carbon monoxide (CO), and ozone (O\n 3<\/jats:sub>\n ) were collected. Hourly onset data of ACS and its subtypes, including ST-segment\u2013elevation myocardial infarction, non\u2013ST-segment\u2013elevation myocardial infarction, and unstable angina, were also obtained. Conditional logistic regressions combined with polynomial distributed lag models were applied.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Acute exposures to PM\n 2.5<\/jats:sub>\n , NO\n 2<\/jats:sub>\n , SO\n 2<\/jats:sub>\n , and CO were each associated with the onset of ACS and its subtypes. These associations were strongest in the concurrent hour of exposure and were attenuated thereafter, with the weakest effects observed after 15 to 29 hours. There were no apparent thresholds in the concentration\u2013response curves. An interquartile range increase in concentrations of PM\n 2.5<\/jats:sub>\n (36.0 \u03bcg\/m\n 3<\/jats:sup>\n ), NO\n 2<\/jats:sub>\n (29.0 \u00b5g\/m\n 3<\/jats:sup>\n ), SO\n 2<\/jats:sub>\n (9.0 \u00b5g\/m\n 3<\/jats:sup>\n ), and CO (0.6 mg\/m\n 3<\/jats:sup>\n ) over the 0 to 24 hours before onset was significantly associated with 1.32%, 3.89%, 0.67%, and 1.55% higher risks of ACS onset, respectively. For a given pollutant, the associations were comparable in magnitude across different subtypes of ACS. NO\n 2<\/jats:sub>\n showed the strongest associations with all 3 subtypes, followed by PM\n 2.5<\/jats:sub>\n , CO, and SO\n 2<\/jats:sub>\n . Greater magnitude of associations was observed among patients older than 65 years and in the cold season. Null associations of exposure to either PM\n 2.5\u201310<\/jats:sub>\n or O\n 3<\/jats:sub>\n with ACS onset were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n The results suggest that transient exposure to the air pollutants PM\n 2.5<\/jats:sub>\n , NO\n 2<\/jats:sub>\n , SO\n 2<\/jats:sub>\n , or CO, but not PM\n 2.5\u201310<\/jats:sub>\n or O\n 3<\/jats:sub>\n , may trigger the onset of ACS, even at concentrations below the World Health Organization air quality guidelines.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/circulationaha.121.057179","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T05:00:15Z","timestamp":1650603615000},"page":"1749-1760","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":203,"title":["Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients"],"prefix":"10.1161","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9448-0820","authenticated-orcid":true,"given":"Renjie","family":"Chen","sequence":"first","affiliation":[{"name":"School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University\u201a Shanghai\u201a China (R.C., Y.J., X.M., Y.G., Weidong Wang, C. Liu, H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixuan","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University\u201a Shanghai\u201a China (R.C., Y.J., X.M., Y.G., Weidong Wang, C. Liu, H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialu","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China (J.H., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honglei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI (H.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huichu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0751-1722","authenticated-orcid":true,"given":"Xia","family":"Meng","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University\u201a Shanghai\u201a China (R.C., Y.J., X.M., Y.G., Weidong Wang, C. Liu, H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Ji","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China (J.S.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University\u201a Shanghai\u201a China (R.C., Y.J., X.M., Y.G., Weidong Wang, C. Liu, H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University\u201a Shanghai\u201a China (R.C., Y.J., X.M., Y.G., Weidong Wang, C. Liu, H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University\u201a Shanghai\u201a China (R.C., Y.J., X.M., Y.G., Weidong Wang, C. Liu, H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiyi","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (W.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbing","family":"Yan","sequence":"additional","affiliation":[{"name":"Center for Coronary Artery Diseases, Chinese Academy of Medical Sciences in Shenzhen, Shenzhen, China (H.Y.)."},{"name":"Center for Coronary Artery Diseases, Chinese Academy of Medical Sciences, Beijing, China (H.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guangdong Provincial People\u2019s Hospital, Guangzhou, China (J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weimin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peking University People\u2019s Hospital, Beijing, China (Weimin Wang)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingcheng","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, General Hospital of Southern Theater Command, Guangzhou, China (D.X.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Wuhan ASIA General Hospital, Wuhan, China (X.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China (B.Y.)."},{"name":"The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China (B.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9976-848X","authenticated-orcid":true,"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen University, Xiamen\u201a China (Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yawei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Tenth People\u2019s Hospital, Shanghai, China (Y.X.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lefeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (L.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunjie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Emergency, Tianjin Chest Hospital, Tianjin\u201a China (C. 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