The impact of COVID-19 pandemic on air particulate matter exposure and heart attacks: a 5-year retrospective cohort study in Taiwan (2017-2021).

Background: Heart attacks including acute ST-segment elevation myocardial infarction (STEMI) and acute decompensated heart failure (ADHF) caused from the particulate matter (PM) and air pollutant exposures are positively associated with regional air pollution severity and individual exposure. The exceptional coronavirus disease epidemic of 2019 (COVID-19) may enhance the air conditions in areas under COVID-19 pandemic. We sought to study the impact of COVID-19 pandemic on air particulate matter (PM) exposure and heart attacks in Taiwan. Methods: This retrospective cohort study was conducted in one teaching hospital in Taichung, Taiwan. We examined emergency patients diagnosed with acute STEMI and ADHF from January 1, 2017, to March 31, 2020, (i.e., before the COVID-19 pandemic) and from April 1, 2020, to December 31, 2021, (after the COVID-19 pandemic). The effects of particulate matter with a diameter of less than 2.5 micrometers (PM2.5) and PM10 as well as temperature and humidity on environmental air pollutants were recorded. The analysis was performed with a unidirectional case-crossover research design and a conditional logistic regression model. Results: Both PM2.5 and PM10 levels had a positive association with the risk of acute STEMI before the COVID-19 pandemic (PM2.5 adjusted odds ratio (OR): 1.016, 95% confidence interval (CI): 1.003-1.032 and PM10 adjusted OR: 1.009, 95% CI: 1.001-1.018) and ADHF (PM2.5 adjusted OR: 1.046, 95% CI: 1.034-1.067 and PM10 adjusted OR: 1.023, 95% CI: 1.027-1.047). Moreover, the results demonstrated that PM2.5 and PM10 were not associated with the risk of acute STEMI or ADHF after the COVID-19 pandemic. Reduction in PM2.5 and PM10 levels after the COVID-19 pandemic were noted. Hospital admissions for acute STEMI (7.4 and 5.8/per month) and ADHF (9.7 and 8.2/per month) also decreased (21.6 and 15.5%) after the COVID-19 pandemic. Conclusion: In Taiwan, paradoxical reductions in PM2.5 and PM10 levels during the COVID-19 pandemic may decrease the number of hospital admissions for acute STEMI and ADHF. As the COVID-19 pandemic eases, the condition of air pollution may gradually become worse again. The governments should formulate better policies to improve the health of the public and the quality of the air.

Effect of Short-Term Exposure to Fine Particulate Matter and Particulate Matter Pollutants on Triggering Acute Myocardial Infarction and Acute Heart Failure.

Long-term exposure to high concentrations of air pollution is known to lead to increased cardiovascular disease, but it remains unclear whether short-term exposure increases the incidence of acute myocardial infarction (AMI) and acute heart failure (AHF). A time-stratified case-crossover design was used, including data from the 2-year period (January 1, 2017 to December 31, 2018), from the National Health Insurance Academic Research Database of Taiwan. Air pollution data were obtained from the Air Quality Monitoring Station of the Environmental Protection Agency of the Executive Yuan. A generalized linear model was used for statistical analysis. In areas with a long-term moderate severity of air pollution, a 10 µg/m3 increase in fine particulate matter (PM2.5) and particulate matter (PM10) exposure in a short period of time coincided with an increase in AMI by 6.5% to 6.7% and 0.9% to 1.1%, respectively, and AHF by 6.1% to 6.4% and 0.9% to 1.0%, respectively. A long-term high severity of air pollution (PM2.5 and PM10) coincided with an increase in AMI by 7.9% to 8.8% and 4.4% to 4.9%, respectively, and AHF by 7.6% to 8.4% and 4.3% to 4.8%, respectively. In areas with a long-term moderate or high severity of air pollution, short-term exposure to high concentrations of PM2.5 and PM10 pollution is positively correlated with AMI and AHF.

Regional air pollution severity affects the incidence of acute myocardial infarction triggered by short-term pollutant exposure: a time-stratified case-crossover analysis.

Long-term exposure to air pollution results in a high incidence of cardiovascular disease. Many studies have found that short-term exposure to air pollution can trigger acute myocardial infarction. This study aims to determine whether results in areas with different levels of severity of air pollution are similar. The study design is a time-stratified case-crossover analysis. This was a retrospective study based on hospital medical records. The study period was since 1 January 2017 to 31 December 2018. Research data were collected from Taoyuan Hospital, located in an area with low severity of pollution, and Taichung Hospital, located in an area with high severity of pollution. The correlation between short-term air pollution exposure and acute myocardial infarction was analyzed. The correlation between short-term exposure to ambient air pollutants and acute myocardial infarction was not significant for the cases collected from Taoyuan Hospital (PM2.5 OR: 1.006 and 95% CI: 0.995-1.017; PM10 OR: 0.996 and 95% CI: 0.988-1.003). However, for the cases collected from Taichung Hospital, short-term exposure to ambient PM2.5 (odds ratio: 1.021; 95% confidence interval: 1.002-1.040) and PM10 (odds ratio: 1.010; 95% confidence interval: 1.001-1.020) resulted in high incidence of acute myocardial infarction. Short-term pollutant exposure will increase the incidence of acute myocardial infarction based on the severity of regional air pollution. In addition to addressing traditional cardiovascular disease risk factors, the government must formulate relevant policies for reducing air pollution and the resulting hazards to citizens' health.

A Rare Case of Pulmonary Thromboembolism without Deep Vein Thrombosis after Nonthermal Nontumescent Ablative Methods for Varicose Vein Surgery.

The NTNT ablative method for varicose vein surgery is characterized by low-difficulty, minimally invasive and fast recovery and make surgeon suppose its very low risks of any major complications. We present a case of PTE without DVT confirmed by ultrasonography and CT angiography (CTA) after NTNT ablative methods for varicose vein surgery.

Identifying the Risk Factor and Prevention of Limb Ischemia in Extracorporeal Membrane Oxygenation with Femoral Artery Cannulation.

OBJECTIVE: Application of extracorporeal membrane oxygenation (ECMO) for life support has been widely used in various fields of resuscitation. When the common femoral artery (CFA) is used during cannulation for ECMO support in adults, it is often complicated by limb ischemia. Placement of distal perfusion catheter (DPC) can reduce the incidence of limb ischemia and increases the likelihood of limb preservation, but selection criteria is uncertain. METHODS: This is a retrospective study. Data was reviewed for patients in one medical center who were supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO) via CFA cannulation percutaneously between January 2008 and June 2014. Two groups were divided into no-ischemia and ischemic limb. Age, sex, height, weight, body surface area (BSA), cannula size, femoral artery diameter, comorbidity, acute physiology and chronic health evaluation (APACHE) II score, vasoactive-inotropic score (VIS) and mortality rate were analyzed. Doppler was used by measuring the distal pulsation in the dorsalis pedis and posterior tibial artery to select the patients. A DPC was prophylactically inserted percutaneously into the superficial femoral artery for antegrade flow to the extremity in the patients who met selection criteria. RESULTS: 139 (43.6%) patients were included in the study and limb ischemia occurred in 46 (33%) of 139. There was a significant difference between the no-ischemia group and the ischemia group in age (55.5 ± 14.2 versus 63.2 ± 13.2; P < .001), common femoral artery diameter (0.82 ± 0.14 versus 0.63 ± 0.17; P < .001 ), known peripheral artery occlusive disease (9% versus 24%; P < .001) and VIS (12.1 ± 8.1 versus 15.8 ± 10.1; P < .001). Mortality rate was higher in the ischemia group (46% versus 26% ; P < .001). 11 patients who met the selection criteria had a DPC prophylactically inserted and no ischemia limb occurred. CONCLUSION: Smaller common femoral artery diameter (≤6.3 cm); known peripheral arterial occlusive disease; higher VIS (≥15.8); absence of distal pulsation pre-cannulation or immediately after post-cannulation or 4 hrs later have higher risk of limb ischemia when CFA cannulation is used for VA-ECMO. Due to this, the mortality and morbidity rate increases when limb ischemia occurs. A DPC should be prophylactically inserted in high-risk patients who meet selection criteria.

New vascular ring connectors in surgery for intramural haematoma of the abdominal aorta progressing to rupture.

Aortic intramural haematoma is similar to classic aortic dissection, which causes a life-threatening medical condition, and immediate diagnosis and treatment are crucial. The optimal therapy for intramural haematoma of the abdominal aorta remains controversial. Conservative medical management is usually the first choice of treatment for uncomplicated cases. Surgical intervention is usually required for complicated intramural haematomas of the abdominal aorta, including conventional open repair and endovascular treatment with stent-grafts. A new vascular ring connector that achieves a quick, blood-sealed and sutureless anastomosis has been designed for aortic dissection. We herein report a case of intramural haematoma of the abdominal aorta, progressing to rupture on day 14 after onset, which had successful aortic repair with the new vascular ring connector. The new vascular ring connector could be an alternative method for the treatment of complicated intramural haematomas of the abdominal aorta.

Aortic perforation caused by friction of a chest tube after coronary artery bypass surgery.

Aortic perforation caused by the friction of a chest tube is a rare but life-threatening complication of coronary artery bypass grafting (CABG). We report a case involving CABG for triple-vessel disease and unstable angina. Reexploration was necessary 24 hours after the operation because of the sudden onset of pronounced bleeding. Perforation of the ascending aorta caused by friction of the chest tube was found. Bleeding was controlled by means of a purse string suture with 4-0 Prolene. Use of pericardium membrane between the heart and the chest tube and the choice of smaller and more flexible Silastic chest tubes in high-risk patients can probably reduce the incidence of this complication.