Environmental constellations and STEMI incidence in southeast Germany - a population-based analysis
P Escrihuela Branz, K Sasse, L Proell, C Merkenschlager, P W Raake, E Hertig, B WeinAbstract
Introduction
ST-elevation myocardial infarction (STEMI) is a life-threatening cardiovascular emergency requiring immediate reperfusion therapy and continuous availability of catheterization facilities. Despite well-established risk factors, the precise triggers determining the timing of acute events remain incompletely understood. Growing evidence suggests that short-term environmental exposures may contribute to the onset of STEMI.
Purpose
However, the effects of multiple environmental factors have not been sufficiently investigated at the population level. Therefore, the ALERT-ITS project analyses the association between extreme environmental conditions and the incidence of STEMI.
Methods
We performed a retrospective population-based time-series (2009-2023) analysis of anonymised statutory health insurance data from a German health insurance institute. Daily STEMI cases, defined by ICD-10-GM criteria, were stratified by sex and age (≥60 vs. <60 years) and assigned to nationwide bio-meteorological regions, with a focus on Southeast Germany. Meteorological and air-quality data included daily mean sea-level pressure (SLP), summer days (SD), hot days (HD), tropical nights (TN), cold-wave duration (CD), and ozone (O₃). Associations were estimated using Quasi-Poisson generalized additive models with distributed lags (weather ≤10 days; pollutants ≤7 days), adjusting for seasonality, long-term trends, and weekday effects.
Results
During the study period, a total of 57,896 confirmed STEMI cases were identified in Southeast Germany. In men ≥60 years, SD (p = 0.044), HD (p = 0.037) and O3 (p = 0.026) were significant predictors. In women ≥60 years, SD (p = 0.001), HD (p = 0.004), CD (p < 0.001), and SLP (p = 0.020) showed significant associations. No predictor reached statistical significance in men <60 years, whereas in women <60 years, SD (p = 0.010) and CD (p = 0.008) were significant. The strongest linear association was observed for SD in women ≥60 years (p = 0.0012), with a relative risk of 0.91 (95% CI 0.85–0.96), corresponding to a 9.3% relative reduction in STEMI incidence on summer days compared with non-summer days.
Conclusion
In Southeast Germany, specific environmental patterns were associated with short-term changes in STEMI incidence, particularly among older patients. Integrating these insights into planning strategies may enhance proactive resource allocation in acute cardiovascular care.