The Interactive and Joint Associations of Ambient PM2.5 and Temperature on the Onset of Acute Coronary Syndrome: Findings from The Chinese Cardiovascular Association (CCA) Database-Chest Pain Center Registry

Environmental factors are important exposures that trigger acute coronary syndrome (ACS) onset. However, the interactive and joint associations of multiple exposures on ACS onset remain unknown. A time-stratified case-crossover study was conducted including 1,292,219 ACS patients who were selected from 1,895 districts/counties across China during 2015-2020. The ACS conditions included ST-segment-elevation myocardial infarction (STEMI), non-ST-segment-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Conditional logistic regression models were applied to estimate the interactive and joint associations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM