Journal of Thrombosis and Thrombolysis

, Volume 45, Issue 2, pp 293–299 | Cite as

Association between short- and medium-term air pollution exposure and risk of mortality after intravenous thrombolysis for stroke

  • Manuel Cappellari
  • Gianni Turcato
  • Massimo Zannoni
  • Stefano Forlivesi
  • Antonio Maccagnani
  • Antonio Bonora
  • Giorgio Ricci
  • Gian Luca Salvagno
  • Gianfranco Cervellin
  • Bruno Bonetti
  • Giuseppe Lippi


The exposure to air pollutants may increase both incidence and mortality of stroke. We aimed to investigate the association of short- and medium-term exposure to particulate matter (PM) and nitrogen dioxide (NO2) with the outcome of intravenous thrombolysis (IVT) for stroke. We conducted a retrospective analysis based on data prospectively collected from 944 consecutive IVT-treated stroke patients. The main outcome measure was 3-month mortality. The secondary outcome measures were causes of neurological deterioration (≥ 1 NIHSS point from baseline or death < 7 days), including intracerebral hemorrhage, cerebral edema (CED), and persistence or new appearance of hyperdense cerebral artery sign. In the adjusted model, higher PM2.5 and PM10 values in the last 3 days and 4 weeks before stroke were independently associated with higher mortality rate [hazard ratio (HR) 1.014, 95% confidence intervals (CI) 1.005–1.024, p = 0.003; HR 1.079, 95% CI 1.055–1.103, p = 0.001; HR 1.019, 95% CI 1.005–1.032, p = 0.008; and HR 1.015, 95% CI 1.004–1.027, p = 0.007; respectively]. Higher PM2.5 and PM10 values in the last 4 weeks were associated with higher CED rate [odd ratio (OR) 1.023, 95% CI 1.007–1.040, p = 0.006; and OR 1.017, 95% CI 1.003–1.032, p = 0.021; respectively]. No significant association between PM or NO2 and other causes of neurological deterioration was observed. Higher exposure to PM in the last 3 days and 4 weeks before stroke may be independently associated with 3-month mortality after IVT. Higher exposure to PM in the last 4 weeks before stroke may also be independently associated with CED after IVT.


Stroke Thrombolysis Air pollution exposure Particulate matter Mortality Cerebral Edema 



We thank Dr. Bovi P., Dr. Tomelleri, Dr. Micheletti, Dr. Ottaviani, Dr. Zanoni, Dr. Deotto, Dr. Scarpelli, Dr. Squintani, Dr. Romito, Dr. Bovi T., Dr. Ferlisi, Dr. Tommasi, Dr. Musso, and Dr. Moretto for the contribution in data collection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11239_2017_1589_MOESM1_ESM.doc (132 kb)
Supplementary material 1 (DOC 132 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Manuel Cappellari
    • 1
  • Gianni Turcato
    • 2
  • Massimo Zannoni
    • 3
  • Stefano Forlivesi
    • 1
  • Antonio Maccagnani
    • 3
  • Antonio Bonora
    • 3
  • Giorgio Ricci
    • 3
  • Gian Luca Salvagno
    • 4
  • Gianfranco Cervellin
    • 5
  • Bruno Bonetti
    • 1
  • Giuseppe Lippi
    • 4
  1. 1.USD Stroke Unit, DAI di NeuroscienzeAzienda Ospedaliera Universitaria IntegrataVeronaItaly
  2. 2.Emergency DepartmentGirolamo Fracastoro Hospital San Bonifacio (Verona)VeronaItaly
  3. 3.Department of Emergency and Intensive CareUniversity Hospital of VeronaVeronaItaly
  4. 4.Section of Clinical BiochemistryUniversity of VeronaVeronaItaly
  5. 5.Emergency DepartmentUniversity Hospital of ParmaParmaItaly

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