{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:37:40Z","timestamp":1762079860776,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,11]],"date-time":"2022-12-11T00:00:00Z","timestamp":1670716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jan Kochanowski University","award":["SUPB.RN.21.257","SUPB.RN.21.126"],"award-info":[{"award-number":["SUPB.RN.21.257","SUPB.RN.21.126"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Air pollution and COVID-19 infection affect the pathogenesis of cardiovascular disease. The impact of these factors on the course of ACS treatment is not well defined. The purpose of this study was to evaluate the effects of air pollution, COVID-19 infection, and selected clinical factors on the occurrence of perioperative death in patients with acute coronary syndrome (ACS) by developing a neural network model. This retrospective study included 53,076 patients with ACS from the ORPKI registry (National Registry of Invasive Cardiology Procedures) including 2395 COVID-19 (+) patients and 34,547 COVID-19 (\u2212) patients. The neural network model developed included 57 variables, had high performance in predicting perioperative patient death, and had an error risk of 0.03%. Based on the analysis of the effect of permutation on the variable, the variables with the greatest impact on the prediction of perioperative death were identified to be vascular access, critical stenosis of the left main coronary artery (LMCA) or left anterior descending coronary artery (LAD). Air pollutants and COVID-19 had weaker effects on end-point prediction. The neural network model developed has high performance in predicting the occurrence of perioperative death. Although COVID-19 and air pollutants affect the prediction of perioperative death, the key predictors remain vascular access and critical LMCA or LAD stenosis.<\/jats:p>","DOI":"10.3390\/ijerph192416654","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T02:15:33Z","timestamp":1670811333000},"page":"16654","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Air Pollution and COVID-19 Infection on Periprocedural Death in Patients with Acute Coronary Syndrome"],"prefix":"10.3390","volume":"19","author":[{"given":"Janusz","family":"Sielski","sequence":"first","affiliation":[{"name":"Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wiek\u00f3w Kielc 19A, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ma\u0142gorzata Anna","family":"J\u00f3\u017awiak","sequence":"additional","affiliation":[{"name":"European Institute of Post-Graduate Education in Kielce, Du\u017ca 21, 25-305 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8407-2527","authenticated-orcid":false,"given":"Karol","family":"Kazir\u00f3d-Wolski","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wiek\u00f3w Kielc 19A, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zbigniew","family":"Siudak","sequence":"additional","affiliation":[{"name":"Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wiek\u00f3w Kielc 19A, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marek","family":"J\u00f3\u017awiak","sequence":"additional","affiliation":[{"name":"Institute of Geography and Environmental Sciences, Jan Kochanowski University in Kielce, Uniwersytecka 7, 25-406 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"574","DOI":"10.33963\/KP.15393","article-title":"Decline in the number of coronary angiography and percutaneous coronary intervention procedures in patients with acute myocardial infarction in Poland during the coronavirus disease 2019 pandemic","volume":"78","author":"Legutko","year":"2020","journal-title":"Kardiol Pol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E568","DOI":"10.1002\/ccd.29134","article-title":"Clinical and procedural characteristics of COVID-19 patients treated with percutaneous coronary interventions","volume":"96","author":"Siudak","year":"2020","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100055","DOI":"10.1016\/j.lanepe.2021.100055","article-title":"In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study","volume":"3","author":"Campo","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114465","DOI":"10.1016\/j.envpol.2020.114465","article-title":"Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy?","volume":"261","author":"Conticini","year":"2020","journal-title":"Env. Pollut"},{"key":"ref_6","first-page":"32","article-title":"Polychlorinated Dibenzo-P-Dioxins and Dibenzofurans (PCDD\/F) Measurements in Ambient Air over the Northern Poland","volume":"7","author":"Niemirycz","year":"2016","journal-title":"Int. J. Chem. Eng. Appl."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/S1352-2310(98)00297-0","article-title":"Atmospheric trace elements in Ankara, Turkey: 1. factors affecting chemical composition of fine particles","volume":"34","author":"Yatin","year":"2013","journal-title":"Atmos. Environ."},{"key":"ref_8","unstructured":"Benini, L., and Asquith, M. (2019). Chapter 16\u2014Understanding Sustainability Challenges. The European Environment\u2014State and Outlook 2020, Publications Office of the European Union."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"147541","DOI":"10.1016\/j.scitotenv.2021.147541","article-title":"The influence of air pollution by PM2.5, PM10 and associated heavy metals on the parameters of out-of-hospital cardiac arrest","volume":"788","author":"Sielski","year":"2021","journal-title":"Sci. Total Env."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/j.resuscitation.2010.08.006","article-title":"Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies","volume":"81","author":"Berdowski","year":"2010","journal-title":"Resuscitation"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wichmann, J., Folke, F., Torp-Pedersen, C., Lippert, F., Ketzel, M., Ellermann, T., and Loft, S. (2013). Out-of-hospital cardiac arrests and outdoor air pollution exposure in Copenhagen, Denmark. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0053684"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Xia, R., Zhou, G., Zhu, T., Li, X., and Wang, G. (2017). Ambient Air Pollution and Out-of-Hospital Cardiac Arrest in Beijing, China. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14040423"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S0140-6736(19)32008-2","article-title":"Modifiable risk factors, cardiovascular disease, and mortality in 155\u2013722 individuals from 21 high-income, middle-income, and low-income countries (PURE): A prospective cohort study","volume":"395","author":"Yusuf","year":"2020","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111154","DOI":"10.1016\/j.envres.2021.111154","article-title":"Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS\u2014Air Pollution Study)","volume":"197","author":"Kralisz","year":"2021","journal-title":"Environ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.33963\/KP.a2021.0133","article-title":"Risk of perioperative death and sudden cardiac arrest: A study of 113,456 cases from the National Registry of Invasive Cardiology Procedures (ORPKI) for estimation of the perioperative prognosis","volume":"79","author":"Sielski","year":"2021","journal-title":"Kardiol. Pol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/107691800300119374","article-title":"Toxic mechanism of nickel exposure on cardiac tissue","volume":"19","author":"Novelli","year":"2000","journal-title":"Toxic Subst. Mech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e007366","DOI":"10.1136\/bmjopen-2014-007366","article-title":"Cadmium exposure and incidence of heart failure and atrial fibrillation: A population-based prospective cohort study","volume":"5","author":"Barregard","year":"2015","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e12437","DOI":"10.1111\/anec.12437","article-title":"Assessment of heart rate response to exercise and recovery during treadmill testing in arsenic-exposed workers","volume":"22","author":"Karakulak","year":"2017","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"870125","DOI":"10.1155\/2011\/870125","article-title":"Heavy metal poisoning and cardiovascular disease","volume":"2011","author":"Alissa","year":"2011","journal-title":"J. Toxicol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/j.ijcard.2015.11.100","article-title":"Ambient air pollution and out-of-hospital cardiac arrest","volume":"203","author":"Kang","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ijcard.2016.10.053","article-title":"The impact of short-term exposure to air pollutants on the onset of out-of-hospital cardiac arrest: A systematic review and meta-analysis","volume":"226","author":"Zhao","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e005355","DOI":"10.1161\/CIRCOUTCOMES.118.005355","article-title":"Causes of Mortality After Percutaneous Coronary Intervention","volume":"12","author":"Bricker","year":"2019","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"Z51","DOI":"10.4244\/EIJ-D-16-00836","article-title":"Poland: Coronary and structural heart interventions from 2010 to 2015","volume":"13","author":"Legutko","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kazir\u00f3d-Wolski, K., Zaj\u0105c, P., Zabojszcz, M., Ko\u0142odziej, A., Sielski, J., and Siudak, Z. (2022). The Effect of COVID-19 on the Perioperative Course of Acute Coronary Syndrome in Poland: The Estimation of Perioperative Prognosis and Neural Network Analysis in 243,515 Cases from 2020 to 2021. J. Clin. Med., 11.","DOI":"10.3390\/jcm11185394"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kazir\u00f3d-Wolski, K., Sielski, J., Sid\u0142o, J., Januszek, R., and Siudak, Z. (2021). The Most Relevant Factors Affecting the Perioperative Death Rate in Patients with Acute Coronary Syndrome and COVID-19, Based on Annual Follow-Up in the ORPKI Registry. Biomedicines, 9.","DOI":"10.3390\/biomedicines9121813"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Sielski, J., Kazir\u00f3d-Wolski, K., Jurys, K., Wa\u0142ek, P., and Siudak, Z. (2021). The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019. J. Clin. Med., 10.","DOI":"10.3390\/jcm10235716"},{"key":"ref_29","unstructured":"Bernardo, J.F. (2022, March 20). Aluminum Toxicity. Available online: https:\/\/emedicine.medscape.com\/article\/165315-overview#showall."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e04691","DOI":"10.1016\/j.heliyon.2020.e04691","article-title":"Heavy metal pollution in the environment and their toxicological effects on humans","volume":"6","author":"Briffa","year":"2020","journal-title":"Heliyon"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s42399-020-00274-4","article-title":"Air Pollution and the Novel Covid-19 Disease: A Putative Disease Risk Factor","volume":"2","author":"Martelletti","year":"2020","journal-title":"SN Compr. Clin. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3730","DOI":"10.1021\/acs.est.0c01102","article-title":"An Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19)","volume":"54","author":"Qu","year":"2020","journal-title":"Environ. Sci. Technol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"138704","DOI":"10.1016\/j.scitotenv.2020.138704","article-title":"Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China","volume":"727","author":"Zhu","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.envint.2018.08.013","article-title":"The effect of environmental lead exposure on human health and the contribution of inflammatory mechanisms, a review","volume":"120","author":"Boskabady","year":"2018","journal-title":"Environ. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1183\/16000617.0122-2017","article-title":"Cadmium in tobacco smokers: A neglected link to lung disease?","volume":"27","author":"Ganguly","year":"2018","journal-title":"Eur. Respir. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s13530-017-0300-x","article-title":"Serum heavy metals and lung function in a chronic obstructive pulmonary disease cohort","volume":"9","author":"Heo","year":"2017","journal-title":"Toxicol. Environ. Health Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s40572-018-0192-1","article-title":"A Meta-analysis of Arsenic Exposure and Lung Function: Is There Evidence of Restrictive or Obstructive Lung Disease?","volume":"5","author":"Sanchez","year":"2018","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3389\/fpubh.2020.00014","article-title":"Environmental and Health Impacts of Air Pollution: A Review","volume":"8","author":"Manisalidis","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/jamacardio.2020.0950","article-title":"Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China","volume":"5","author":"Shi","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/S0140-6736(20)31356-8","article-title":"COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England","volume":"396","author":"Mafham","year":"2020","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"683683","DOI":"10.3389\/fpubh.2021.683683","article-title":"Association Between Air Pollution and Acute Coronary Syndromes During Lockdown for COVID-19: Results From the Terni Hub Center","volume":"9","author":"Arrivi","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1093\/ije\/dyy073","article-title":"A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease","volume":"47","author":"Moon","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"353","DOI":"10.3109\/13547501003763369","article-title":"Characteristics of a nickel-albumin binding assay for assessment of myocardial ischaemia","volume":"15","author":"Becker","year":"2010","journal-title":"Biomarkers"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1515\/CCLM.2011.063","article-title":"Assessment of the nickel-albumin binding assay for diagnosis of acute coronary syndrome","volume":"49","author":"Signor","year":"2011","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_45","first-page":"252","article-title":"Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area","volume":"62","author":"Versaci","year":"2020","journal-title":"Panminerva. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1161\/CIRCULATIONAHA.121.057179","article-title":"Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients","volume":"145","author":"Chen","year":"2022","journal-title":"Circulation"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14017431.2017.1405069","article-title":"Impact of climate and air pollution on acute coronary syndromes: An update from the European Society of Cardiology Congress 2017","volume":"52","author":"Aunan","year":"2018","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.1093\/eurheartj\/ehaa411","article-title":"Where have all the myocardial infarctions gone during lockdown? The answer is blowing in the less-polluted wind","volume":"41","author":"Picano","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ijcard.2020.12.059","article-title":"Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020","volume":"329","author":"Versaci","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.33963\/KP.a2021.0142","article-title":"Is neural network better than logistic regression in death prediction in patients after ST-segment elevation myocardial infarction?","volume":"79","author":"Niedziela","year":"2021","journal-title":"Kardiol. Pol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"127571","DOI":"10.1016\/j.chemosphere.2020.127571","article-title":"Heavy metals in submicronic particulate matter (PM(1)) from a Chinese metropolitan city predicted by machine learning models","volume":"261","author":"Li","year":"2020","journal-title":"Chemosphere"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/24\/16654\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:39:21Z","timestamp":1760146761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/24\/16654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,11]]},"references-count":51,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192416654"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192416654","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,12,11]]}}}