Residential exposome and the risk of coronary obstruction and myocardial ischaemia detected by coronary computed tomography

Abstract

Aims To assess independent impacts of air and noise pollution and residential green exposure on non-invasively derived coronary obstruction and myocardial ischaemia. Methods and results Consecutive patients screened by coronary computed tomography angiography (CCTA) for stable chest pain between 1 January 2019 and 31 December 2020 were included in a registry. Exposure associations between residential PM2.5 (particulate matter <2.5 mu m), NO2 (nitric dioxide), major road distance, airport distance, normalized difference vegetation index, obstructive coronary artery disease (OCAD, stenosis >= 50%), and abnormal fractional flow reserve (FFRCT <= 80%) measurements were assessed by propensity score (PS)-adjusted logistic regression. A subgroup analysis was performed according to Framingham low (<10%) and high (>20%) 10-year coronary heart disease risk categories. A total of 2620 patients were enrolled, including 420 (16%) FFRCT analyses. OCAD was reported in 518 (20%) patients and abnormal FFRCT in 276 (11%). People with OCAD lived closer to the airport [10.841 (7.869-19.022) km vs. 12.297 (8.691-22.843) km, P < 0.001). People living closer to the airport had more cardiovascular (CV) and socio-economic risk factors. Distance to airport decreased OCAD risk (OR 0.983, 95% CI 0.974-0.992, per 1 km) in univariable analysis. After PS adjustment, environmental stressors were not significantly associated with OCAD, regardless of risk categories. Only distance to major road decreased abnormal FFRCT risk (OR 0.634, 95% CI 0.421-0.926, per 1 km) in high-risk patients after PS adjustment. Conclusion We found no clear environmental associations with CT-derived coronary obstruction or ischaemia. However, airport proximity was linked to OCAD risk via CV and socio-economic factors, while major road proximity was independently associated with myocardial ischaemia in high-CV-risk patients, warranting further investigation.