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Warm winter is associated with low incidence of ST elevation myocardial infarctions and less frequent acute coronary angiographies in an alpine country

Ein warmer Winter ist mit einer geringeren Inzidenz von ST-Hebungs-Myokardinfarkten und weniger akuten Koronarangiographien in einem alpinen Land assoziiert

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Abstract

Background

Weather conditions influence symptoms in chronic stable coronary artery disease (CAD). Whether the ongoing climate change, with continuous and rapid temperature increases, also has an impact on the incidence and outcome of non-ST elevation (NSTEMI) and ST elevation (STEMI) myocardial infarctions referred for acute coronary angiography (CA) is less clear.

Methods

According to weather data from the Institute of Meteorology and Geophysics, Innsbruck University, the 2005/2006 winter was very cold (CW) and the 2006/2007 winter extraordinarily warm (WW). As the overall invasive management of patients with acute coronary syndromes did not change substantially within these winters, we compared patients referred for acute CA suffering an acute STEMI or NSTEMI, their risk factors and in-hospital mortality rates between these two consecutive winters.

Results

As expected, the average temperature was lower (− 1.6 vs. + 5.9°C; p < 0.001) and humidity was higher (82 vs. 79%; p < 0.012) in CW compared to WW, with no significant differences in other weather conditions (rainfall: 59 vs. 39 days; sunshine: 3.9 vs. 4.3 h/day; air pressure: 713.04 vs. 713.76 hPa). There were no differences in the number of overall CA (987 vs. 983) between these two winters, whereas the number of acute CA (12.9 vs. 10.4% of overall CA; p = 0.046) and the diagnosis of STEMI as an indication of acute CA (74.0% vs. 62.7%; p = 0.046) were higher in CW. Furthermore, patients in CW were younger (58.2 ± 12.4 vs. 61.7 ± 11.7 years; p < 0.03), had higher LDL cholesterol (134.8 ± 44.6 vs. 116.7 ± 36.0 mg/dl; p < 0.003) and were less frequently hypertensives (52.8 vs. 70.6%; p < 0.01). Other traditional risk factors were not different between WW and CW. In addition, there were no differences in in-hospital mortality rates in invasively diagnosed CAD, patients’ nationalities (Austrians: 78.0 vs. 77.5%) and time from pain to arrival in the cath lab in STEMI patients (3.9 ± 3.5 vs. 3.8 ± 3.1 h).

Conclusion

The average temperature increase of 7.5°C from the cold to the warm winter was associated with a decrease in acute coronary angiographies, in particular due to a lower incidence of STEMI referred for primary percutaneous intervention.

Zusammenfassung

Hintergrund

Die Symptome der stabilen koronaren Herzerkrankung (KHK) sind bekanntermaßen witterungsabhängig. Angesichts rasanter Klimaveränderungen stellt sich die Frage, ob stetig steigende Temperaturen auch einen Einfluss auf die Inzidenz invasiv abgeklärter Nicht-ST-Hebungs-(NSTEMI)- und ST-Hebungs-Herzinfarkte (STEMI) hat.

Methode

Laut Wetterdaten galt in Innsbruck der Winter 2005/2006 als sehr kalt und der Winter 2006/2007 als mild. Da innerhalb dieser Jahre keine wesentlichen Änderungen im invasiven Management akuter Koronarsyndrome (ACS) stattfanden, verglichen wir in diesen beiden konsekutiven Wintern die Zahl der Patienten, die aufgrund eines ACS zur akuten Herzkatheteruntersuchung (Akut-CAG) zugewiesen wurden, ihre Risikofaktoren und deren Krankenhaussterblichkeit.

Resultate

Im kalten Winter war die durchschnittliche Temperatur niedriger (− 1,6 vs. + 5,9°C; p < 0,001) und die Luftfeuchtigkeit höher (82 vs. 79%; p < 0,012) als im warmen Winter, wobei die übrigen Wetterparameter nicht unterschiedlich waren (Tage mit Regen: 59 vs. 39; Sonnenstunden/Tag: 3,9 vs. 4,3; Luftdruck: 713,04 vs. 713,76 hPa). Die Anzahl der gesamten CAG (elektiv und akut) war in beiden Wintern ähnlich (987 vs. 983). Der Anteil der Akut-CAG (12,9 vs. 10,4%; p = 0,046) und die Häufigkeit eines STEMI (74,0 vs. 62,7%; p = 0,046) waren im kalten Winter höher. Des Weiteren waren Patienten mit ACS im kalten Winter jünger (58,2 ± 12,4 vs. 61,7 ± 11,7 Jahre; p < 0,03), hatten höhere LDL-Cholesterin-Sspiegel (134,8 ± 44,6 vs. 116,7 ± 36,0 mg/dl; p < 0,003) und waren seltener Hypertoniker (52,8 vs. 70,6%; p < 0,01). Die übrigen kardiovaskulären Risikofaktoren waren nicht signifikant unterschiedlich. Außerdem zeigte sich kein Unterschied in der Krankenhaussterblichkeit aller invasiv abgeklärten ACS (2,4 vs. 1,0%; p = NS), der Nationalität der Patienten (Österreich: 78,0 vs. 77,5%) und in der Zeit von Schmerzbeginn bis Eintreffen im Herzkatheterlabor bei Patient(inn)en mit STEMI (3,9 ± 3,5 vs. 3,8 ± 3,1 h) zwischen beiden Wintern.

Diskussion

Der deutliche Temperaturanstieg von 7.5° C innerhalb zweier Winter war mit einem signifikanten Rückgang der Akut-CAG bedingt, welcher vorwiegend durch eine Abnahme der zu einer Primär-PCI zugewiesenen Patienten/innen mit STEMI bedingt war.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Cardiology, University Clinic of Internal Medicine III, Anichstr. 35, 6020, Innsbruck, Austria

    M. Wanitschek, H. Ulmer, A. Süssenbacher, J. Dörler, O. Pachinger &  H.F. Alber

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  1. M. Wanitschek
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  2. H. Ulmer
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  3. A. Süssenbacher
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  6. H.F. Alber
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Wanitschek, M., Ulmer, H., Süssenbacher, A. et al. Warm winter is associated with low incidence of ST elevation myocardial infarctions and less frequent acute coronary angiographies in an alpine country. Herz 38, 163–170 (2013). https://doi.org/10.1007/s00059-012-3639-4

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  • DOI: https://doi.org/10.1007/s00059-012-3639-4

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