Fine Particulate Matter Exposure and Risk of Major Adverse Cardiac and Cerebrovascular Events (MACCE) in Post-Percutaneous Coronary Intervention (PCI) Patients: A Thai PCI Registry-Based Cohort Study

Background: Major adverse cardiac and cerebrovascular events (MACCE) are critical clinical outcomes in patients undergoing percutaneous coronary intervention (PCI); however, evidence regarding the impact of fine particulate matter (PM2.5) on these outcomes remains limited. Methods: This retrospective cohort study included 22,188 Thai adults who underwent PCI to investigate the association between PM2.5 exposure and the incidence of MACCE. Baseline demographic, clinical characteristics, and comorbidities, with angiographic and procedural data, were collected. Cumulative PM2.5 exposure was estimated using satellite-derived data based on patients' residential locations over a 12-month follow-up period. The primary outcome was a composite MACCE endpoint. A multilevel survival model was employed to assess the association between PM2.5 exposure and MACCE, adjusting for potential confounding variables. Results: During the median follow-up of 11.97 months (ranging from 0.03 to 12 months), 6,382 patients (28.8%) experienced at least one MACCE. PM2.5 levels in Thailand exhibit a distinct seasonal pattern, peaking around February (Quarter 1; Q1) and reaching their lowest levels in Q3. In the final multivariable model, a 1 μg/m³ increase in PM2.5 exposure was associated with MACCE (adjusted hazard ratio (HR) 1.45 (95% CI: 1.37, 1.54)). The adjusted HR for PM2.5 comprising quarterly seasonal variations was as follows: 1.015 (95% CI: 1.005, 1.024) in Q4, 1.222 (95% CI: 1.132, 1.319) in Q1, 1.177 (95% CI: 1.096, 1.265) in Q2, and 1.500 (95% CI: 1.381, 1.629) in Q3. Conclusion: The study's findings suggested that higher seasonal PM2.5 exposure is associated with MACCE in patients who underwent PCI. These results underscore the urgent need for public health policies that focus on reducing PM2.5 to improve health outcomes and reduce the burden of the disease.