Short-term exposure to environmental parameters and onset of ST elevation myocardial infarction. The CARDIO-ARSIF registry ☆ Christophe Caussin a , Sylvie Escolano b , Hazrije Mustafic b , Sophie Bataille c , Muriel Tafflet b , Edouard Chatignoux d , Yves Lambert e , Hakim Benamer f,g , Philippe Garot h , Patricia Jabre b , Laurent Delorme i , Olivier Varenne j , Emmanuel Teiger k , Bernard Livarek l , Jean-Philippe Empana b,1 , Christian Spaulding b,m,1, ⁎, Xavier Jouven b,m,1 , for the CARDIO-ARSIF Registry Investigators a Institut Mutualiste Montsouris, Paris, France b INSERM Unit 970 Paris Cardiovascular Research Center, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France c Agence Régionale de Santé d'Ile de France, Paris, France d Observatoire Régional de Santé d'Ile de France, Paris, France e SAMU 78, CH Versailles, France f Hôpital Foch, Suresnes, France g ICPS, Massy, France h ICPS, Quincy, France i Hôpital Bichat, Paris, France j Hôpital Cochin, France k Hôpital Henri Mondor, Créteil, France l Department of Cardiology, CH Versailles, France m Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France abstract article info Article history: Received 30 October 2014 Received in revised form 30 December 2014 Accepted 26 January 2015 Available online 28 January 2015 Keywords: Air pollutants Influenza Myocardial infarction Climate Acute coronary syndrome Background: Environmental parameters have been reported to be triggers of acute myocardial infarction (MI). However, the individual role of each parameter is unknown. We quantified the respective association of climate parameters, influenza epidemics and air pollutants with the onset of ST elevation MI (STEMI) in Paris and the sur- rounding small ring. Methods: Data from the CARDIO-ARSIF registry (Paris and small ring STEMI population), Météo France (Climate), GROG (Influenza epidemic) and AIRPARIF (Air Pollution) were analyzed. The association between short-term ex- posure (1 day lag time) to environmental parameters and STEMI occurrence was quantified by time series modeling of daily STEMI count data, using Poisson regression with generalized additive models. Results: Between 2003 and 2008, 11,987 b 24H STEMI confirmed by angiography were adjudicated. There was a 5.0% excess relative risk (ERR) of STEMI per 10 °C decrease in maximal temperature (95% CI 2.1% to 7.8%: p = 0.001) and an 8.9% ERR (95% CI 3.2% to 14.9%: p = 0.002) during an influenza epidemic after adjustment on week-days and holidays. Associations were consistent when short-term exposure varied from 2 to 7 days. Asso- ciations between lower temperatures and STEMI were stronger in magnitude when influenza epidemic was present. Short-term exposure to climatic parameters or pollutants was not associated with STEMI. Conclusions: The present population based registry of STEMI suggests that short-term exposure to lower temper- ature and influenza epidemic is associated with a significant excess relative risk of STEMI. Subjects at risk for MI may benefit from specific protections against cold temperature and influenza infection. © 2015 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Environmental parameters as triggers of ST elevation acute myocar- dial infarction (STEMI) have been identified [1–3]. Several studies have reported significant increased risk of STEMI with exposure to climate parameters like extreme temperatures [4–14], humidity [15], low atmo- spheric pressure [5,12], and influenza virus infection [16–19]. Short and long term exposure to different air pollutants may also play a role in the onset of STEMI; however, the precise role of pollution International Journal of Cardiology 183 (2015) 17–23 ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. ⁎ Corresponding Author at: Christian Spaulding, Department of Cardiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. E-mail address: christian.spaulding@egp.aphp.fr (C. Spaulding). 1 All three authors have contributed equally to the manuscript. http://dx.doi.org/10.1016/j.ijcard.2015.01.078 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard