Atmospheric features and risk of ST-elevation myocardial infarction in Porto (Portugal): A temperate Mediterranean (Csb) city

array:24 ["pii" => "S087025512100456X" "issn" => "08702551" "doi" => "10.1016/j.repc.2020.11.015" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1857" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2022;41:51-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0870255121004601" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.11.004" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1861" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2022;41:59-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial comment" "titulo" => "Exposome and cardiometabolic health: Temperature change and humidity are part of the puzzle" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "60" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Expossoma e a saúde cardiometabólica: mudanças de temperatura e de humidade são partes do quebra-cabeça" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Claudio Tinoco Mesquita, Fernanda Azevedo-Silva" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Claudio" "apellidos" => "Tinoco Mesquita" ] 1 => array:2 [ "nombre" => "Fernanda" "apellidos" => "Azevedo-Silva" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004601?idApp=UINPBA00004E" "url" => "/08702551/0000004100000001/v1_202202030626/S0870255121004601/v1_202202030626/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255121004595" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.11.003" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1860" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2022;41:49-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial comment" "titulo" => "Pregnancy and electrocardiogram: Can a basic tool help us to understand a complex and understudied population?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "50" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Gravidez e ECG: poderá uma ferramenta básica ajudar a compreender uma população complexa e subestudada?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "André Viveiros Monteiro" "autores" => array:1 [ 0 => array:2 [ "nombre" => "André Viveiros" "apellidos" => "Monteiro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004595?idApp=UINPBA00004E" "url" => "/08702551/0000004100000001/v1_202202030626/S0870255121004595/v1_202202030626/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Atmospheric features and risk of ST-elevation myocardial infarction in Porto (Portugal): A temperate Mediterranean (Csb) city" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "51" "paginaFinal" => "58" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Susete Vieira, Mariana Santos, Rui Magalhães, Marta Oliveira, Ricardo Costa, Bruno Brochado, Raquel B. Santos, João Silveira, Severo Torres, André Luz" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Susete" "apellidos" => "Vieira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Mariana" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rui" "apellidos" => "Magalhães" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Marta" "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Costa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Bruno" "apellidos" => "Brochado" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Raquel B." "apellidos" => "Santos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "João" "apellidos" => "Silveira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Severo" "apellidos" => "Torres" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 9 => array:4 [ "nombre" => "André" "apellidos" => "Luz" "email" => array:1 [ 0 => "andrecoimbraluz@hotmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "ICBAS School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Características atmosféricas e risco de enfarte com elevação de ST no Porto (Portugal) – uma cidade com clima mediterrâneo temperado (Csb)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2720 "Ancho" => 2925 "Tamanyo" => 343596 ] ] "descripcion" => array:1 [ "en" => "Monthly variation in temperature, atmospheric pressure and relative humidity and the number of events." ] ] ] "textoCompleto" => "IntroductionThe pathophysiology of an ST-elevation myocardial infarction (STEMI) usually begins with a rupture or erosion of an atherosclerotic plaque followed by coronary spasm and the activation of both platelets and coagulation cascade.<a class="elsevierStyleCrossRef" href="#bib0240">1</a> This leads to thrombus formation and to a sudden obstruction of a coronary artery culminating in myocardial necrosis. To salvage the myocardium, immediate recanalization is warranted, preferably by a primary percutaneous coronary intervention (PCI). Aside from traditional cardiovascular risk factors which are related to atherosclerosis and hence to a heightened risk of a major coronary event, the exact trigger associated with the onset of a STEMI is not always evident.<a class="elsevierStyleCrossRef" href="#bib0245">2</a> In the past few years, epidemiological studies have shown that some chronobiological and environmental parameters such as pollution, abrupt changes in air temperature, relative humidity, rainfall, and atmospheric pressure have been related to an increased incidence of STEMI.<a class="elsevierStyleCrossRefs" href="#bib0250">3–7</a> In Portugal, a study of two major cities showed an association between temperature fall and hospital admissions for myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0270">7</a> Although the risk ratio of environmental triggers to the onset of myocardial infarction has been reported to be small, it exposes the entire population on a continuous and involuntary basis. By addressing its putative relationship, health authorities can be alerted regarding an expected rise in the incidence of STEMI. Since many of the robust data come from latitudes that have particular climatic features,<a class="elsevierStyleCrossRefs" href="#bib0255">4,8–11</a> there is a paucity of data regarding its impact in a temperate Mediterranean region. Furthermore, many reports capture either a broad definition of myocardial infarction,<a class="elsevierStyleCrossRefs" href="#bib0295">12,13</a> or sometimes its diagnosis comes from an administrative codification without having confirmation via PCI.<a class="elsevierStyleCrossRefs" href="#bib0300">13,14</a> This may have led to ascertainment bias. With this study, we sought to assess the impact of atmospheric parameters on the incidence of STEMI in a population who underwent PCI, attended by a tertiary care center in the city of Porto, Portugal.MethodsStudied population and definitionsThis study is a retrospective analysis of STEMI-patients treated with primary PCI at CHUP – Centro Hospitalar Universitário do Porto – between 1 January 2010 and 31 December 2017. STEMI-patients were diagnosed after clinical and electrocardiographic criteria as explained elsewhere,<a class="elsevierStyleCrossRef" href="#bib0310">15</a> only those who were admitted to our center and who had an angiographic lesion assessed by invasive coronariography compatible with the clinical setting were considered for analysis. Those who did not go to the hospital, died before intervention or did not undergo PCI for any reason and hence a culprit lesion was not confirmed, were excluded. All STEMI-patients treated at our center were included in a prospective anonymized database where demographic, clinical, and procedural features were registered.Patient informed consent for the current study was waived because the records were anonymized. This study was approved by the local ethics committee (local number 223-DEFI/235-CE) and was conducted in accordance with the revised Declaration of Helsinki.Climate characteristicsPortugal is a country in the Western Europe with a Mediterranean climate. Porto is its second biggest city with a population of approximately 1.7 million living in its metropolitan area (approximate 2000 km2). Our PCI center covers around 400 000 inhabitants without significant meteorological disparities. According to Koppen-Geiger, Porto's climate is classified as a warm-summer Mediterranean climate (Csb),<a class="elsevierStyleCrossRef" href="#bib0315">16</a> which is characterized by a lack of mildly hot temperatures, a cold and rainy winter and fall, and a mild, hot summer and spring.Meteorological data was obtained from the Portuguese Institute for Sea and Atmosphere I.P., a government-lead institute, from 2010 to 2017 – a total of 2922 days. Most of the data were registered in the Pedras Rubras (88.4% of days) station and the remaining at Serra do Pilar (9.3% of days) and São Gens (2.3% of days) stations. These gather the overall meteorological conditions representative of the area covered by our center. The following variables were collected: atmospheric temperature (expressed in °C) mean (Tmean), minimum (Tmin), maximum (Tmax), relative humidity (%, mean), rainfall (expressed in mm; mean), atmospheric pressure (expressed in hPa; mean). Missing values of meteorological parameters were inputted using the mean of the flanking values, with exception for precipitation. Because analysis with and without inputted missing values were similar, the analyzed data was performed after inputted missing values. Definition of seasons was used by the meteorological criteria as follows: Summer includes June, July and August months; Fall includes September, October and November; Winter includes December, January and February; Spring includes March, April and May.Statistical analysisStatistical analysis was performed with IBM SPSS Statistics (v.26) using GLM with a Poisson distribution. For ascertaining the effect of meteorological variables, a series of models were considered for exposure at different hazard periods before the event - same day to previous seven days and the average values of two-day to seven-day period. As the individualized cases were not used, adjustment to the clinical variables from the data was not performed.The effects (GLM coefficients) are presented as excess relative risk (ERR) for a unit drop in the temperature parameters – maximum, minimum and median temperature. The other meteorological parameters - diurnal temperature range (DTR), relative humidity, precipitation and atmospheric pressure - are presented for a unit rise. Univariate and multivariable analysis were computed to study independent parameters which predicted a higher risk of STEMI occurrence. Statistical significance was set for a two-tailed p-value <0.05, unadjusted for multiplicity.ResultsOverall, 1004 STEMI-patients confirmed by PCI had full data available and were included in the study (mean 0.3 STEMI per day). Patients’ mean age was 62.5±12.9 years and 75% were men.Meteorological parameters are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. As expected, summer was the hottest season and winter the coldest. The rainiest seasons were fall and winter. Relative humidity (RH) was also higher in these seasons, whereas the atmospheric pressure was higher during the winter.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Monthly variation in temperature is depicted in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>. A higher number of STEMI was appreciated from October to January, as well as in the months of April and May.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Although we did not encounter statistically significant seasonality, we observed an increased risk ratio in fall, winter and spring, as compared to summer (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>We found several associations between STEMI occurrence and different temperature parameters at different hazard periods. For a 1°C drop in minimum temperature (Tmin), at preceding two, three and six days, relative risk of STEMI increases 2.0%, 1.8% and 1.4%, respectively (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a> and supplemental Table 1). A similar association was found when considering the mean values of Tmin in different hazard periods before the event (two-day to seven-day period). We also found an excess risk for each drop of 1°C in maximum temperature (Tmax) in the preceding two, three and four days before the event (ERR=1.3%, 1.5% and 1.4% respectively). We observed a similar association when considering the mean values of Tmax in different hazard periods before the event (three-day to seven-day period). Finally, a 1°C drop in Tmean in the preceding two, three and four days was associated with an increase of 1.7%, 1.8% and 1.4% in the risk of STEMI. The same association was observed with a decrease in the average values of Tmean in the days before, for all the hazard period considered: two-day to seven-day period (ERR ranging from 1.5 to 1.7%). Besides temperature, we also found that for a 1% increase in relative humidity three days before the event, the risk of STEMI increased 0.5%. We did not find any association between STEMI occurrence and diurnal temperature range, precipitation and atmospheric pressure.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the stepwise models, the most important predictors of STEMI occurrence are Tmin two days before the event (ERR=1.9%, 95% confidence interval (CI) 0.5 to 3.3%, p=0.009) and a 1% increase in relative humidity three days before the event (ERR=0.7%, 95%CI 0.2 to 1.3%, p=0.006) for an excess of risk, while the same increase in relative humidity one day before the event (ERR=-0.6%, 95%CI -1.1 to -0.1%, p=0.023) was associated with a lower risk.DiscussionThe main findings of this study are as follows: (1) a drop in Tmin two days before the event is associated with a higher ERR; (2) the highest RH in the previous three days is associated with a higher ERR, whereas the highest RH one day before the event is associated with a lower ERR; (3) although seasonality was not confirmed, there is an higher relative risk in fall, winter and spring, as compared to summer; (4) diurnal temperature range, atmospheric pressure and precipitation did not show any significant impact.Our results are aligned with most studies on this subject.<a class="elsevierStyleCrossRefs" href="#bib0260">5,6,12,17–21</a> At least three European studies (from across Belgium, Madrid, and Paris areas), which had also only included STEMI-patients undergoing PCI, showed that a drop in temperature was related to an excess risk of STEMI.<a class="elsevierStyleCrossRefs" href="#bib0265">6,19,21</a> Conversely, in another European cohort (Rome region), a higher temperature in the summer was related to an increased risk of STEMI.<a class="elsevierStyleCrossRef" href="#bib0345">22</a> None of these regions have the same climatic characteristics as our city.Close to our location, two studies aimed to assess the incidence of acute cardiac disease in relation to climate changes. One study came from Galicia, (Northern Spain), where some regions share the same type of climate as Northern Portugal,<a class="elsevierStyleCrossRef" href="#bib0350">23</a> and aimed to assess the impact of daily meteorological parameters. They failed to show a relationship between daily temperature and the incidence of a myocardial infarction. The other study came from Portugal,<a class="elsevierStyleCrossRef" href="#bib0270">7</a> encompassing data gathered from the two major cities: Lisbon (which as has a Mediterranean Csa Climate) and Porto, and investigated the impact of cold weather on the incidence of acute myocardial infarction captured from diagnosis-related groups database (Coded ICD9:410). They found that for every degree drop in temperature during the winter, there was an increase of up to 2.2% (95% CI=0.9%; 3.3%) in daily hospital admissions for myocardial infarction.The strength of our study is twofold: first, we studied a population in a temperate Mediterranean climate living in a relatively small area without major meteorological disparities, and second, by only including patients presenting with an occluded coronary artery, as confirmed by invasive angiography, we believe the impact of climate on the incidence of an acute myocardial infarction was better ascertained. By analyzing <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, a lower temperature starting in October is related to a steady rise in the number of events, which then stabilizes and diminishes in the coldest months of January to March. The same trend has been observed in other series,<a class="elsevierStyleCrossRefs" href="#bib0305">14,24</a> highlighting that it is probably temperature variation, rather than absolute seasonal low temperature that closely relates to cardiac events. This may suggest that vascular biology is more sensitive to the lowering of temperatures until it adapts. According to one systematic review,<a class="elsevierStyleCrossRef" href="#bib0360">25</a> countries with a higher latitude have a less meaningful association between exposure to the cold and the number of events, presumably because of the adaptive physiological response to lower temperatures, but also by taking precautionary behavior against the cold.Mechanisms that lead to these associations are multifactorial.<a class="elsevierStyleCrossRefs" href="#bib0245">2,3,26</a> One of the hypotheses is the cold-related activation of sympathetic nervous system.<a class="elsevierStyleCrossRef" href="#bib0370">27</a> Increased levels of catecholamines lead to a higher heart rate which increases oxygen demands and also reduce the duration of diastole, creating an impediment to coronary blood flow.<a class="elsevierStyleCrossRef" href="#bib0375">28</a> Moreover, to maintain a constant core body temperature in low temperatures, vessels constrict to suppress heat dissipation, which leads to higher blood pressure.<a class="elsevierStyleCrossRefs" href="#bib0260">5,29,30</a> This process of vasoconstriction due to cold can also alter the arterial wall shear stress and lead to plaque rupture. Nonetheless, other physiological reasons were investigated to explain this association and some studies show that colder temperatures have pro-coagulant properties which may heighten the risk of myocardial infarction.<a class="elsevierStyleCrossRefs" href="#bib0390">31,32</a> It is also plausible that the activation of the sympathetic nervous system leads to a higher production of new platelets, which are more capable of aggregating and adhering to the vessel wall, promoting thrombosis.<a class="elsevierStyleCrossRef" href="#bib0400">33</a> Cold temperatures are also related to a higher number of respiratory infections, namely influenza, which has also been linked to a heightened risk of myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0365">26</a> Although some studies have shown a rise in cholesterol levels in winter which could act as a cofactor, it appears that this effect may just be due to hemoconcentration, and so the absolute value of cholesterol is not different from other seasons.<a class="elsevierStyleCrossRef" href="#bib0405">34</a> Nevertheless, it is plausible that in winter the average caloric intake is higher than in other seasons, raising the risk not only attributed to a gluco-metabolic dysregulation but also to reduced physical activity and depression.<a class="elsevierStyleCrossRefs" href="#bib0410">35,36</a>Contrary to our findings, some series showed that the incidence of STEMI is increased when there is a rise in temperature,<a class="elsevierStyleCrossRefs" href="#bib0345">22,37</a> especially in susceptible populations,<a class="elsevierStyleCrossRef" href="#bib0425">38</a> whereas others refute any association between the incidence of STEMI and meteorological conditions. These differences may be ascribed to the latitude of the country where the study was undertaken. Similar to other reports, in our series, in the summer there was a lower relative risk compared to other seasons.<a class="elsevierStyleCrossRefs" href="#bib0270">7,23,26,39,40</a> We did also find an increased incidence of STEMI in the months from March to May. Although we do not have a simple explanation for this, it is tempting to speculate that a temperature rise may also trigger more events, as was found in some European cohorts.<a class="elsevierStyleCrossRefs" href="#bib0345">22,37,38</a> Some authors have shown that hourly exposure (six hours) to increasing ambient temperature was associated with an excess risk of a myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0440">41</a> Since we did not capture these ultra-short variations, a positive association with increasing temperature may have been missed.It seems that the relationship between temperature and the risk of a myocardial infarction is U-shaped, influenced by both increasing and decreasing temperature,<a class="elsevierStyleCrossRef" href="#bib0445">42</a> followed by the observation that temperature extremes are associated with an excess in cardiac death.<a class="elsevierStyleCrossRef" href="#bib0450">43</a>Besides temperature, this investigation also showed an excess risk of STEMI for a 1% increase in RH three days before the event. The opposite results for the same RH variation in lag three and lag one are not easy to interpret. Not only does it likely reflect imbalances in core body temperature and water homeostasis,<a class="elsevierStyleCrossRef" href="#bib0295">12</a> but it may also reflect the effect of unknown confounders undermining a cause and effect relationship in unidimensional appraisal.<a class="elsevierStyleCrossRef" href="#bib0455">44</a> Contradictory results have been reported, either increasing<a class="elsevierStyleCrossRef" href="#bib0350">23</a> or decreasing<a class="elsevierStyleCrossRef" href="#bib0280">9</a> the risk for an acute coronary event for a given increase or decrease in ambient RH. Interestingly, one study showed that the concentrations of fine-particulate matter (PM2.5) was dependent on RH, raising the water-soluble components (especially inorganic ions), the water-soluble organic carbon to organic carbon ratio, pointing to the formation of secondary organic aerosols.<a class="elsevierStyleCrossRef" href="#bib0460">45</a> Since PM2.5 has been associated with cardiovascular risk, including myocardial infarction,<a class="elsevierStyleCrossRef" href="#bib0465">46</a> RH may be a key factor in an increase in air pollutants such PM2.5. Finally, differences in methods to ascertain this effect may result in conflicting results.A relation between the atmospheric pressure and the number of events was not found. This might be related to the lack of variability of this atmospheric parameter when compared to the temperature variation.<a class="elsevierStyleCrossRef" href="#bib0415">36</a>LimitationsThere are some limitations to this study. One major limitation is that all STEMI-patients that died before treatment were not considered for analysis, thereby not considering whether climate triggers were associated with a particularly severe and a rapidly fatal outcome. Nevertheless, by only addressing those who arrived at the hospital alive and who had a confirmatory PCI, we may have reduced ascertainment bias. Another major concern, which has also been addressed in other similar studies, is that the outdoor meteorological conditions may not reflect indoor and core body temperatures. We did not measure air pollution, which has been associated with triggering myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0470">47</a> This might have acted as a confounded factor impacting our results. Finally, we did not include the other two tertiary care hospitals in the same city, which may also have a large group of patients sharing the same atmospheric characteristics.ConclusionsIn a contemporary series of STEMI-patients treated with primary PCI, climate had a significant association with STEMI incidence in a city without extreme meteorological variations. A higher risk is to be expected with the lower minimum temperature two days before the event, and a higher relative humidity three days before the event. Conducting a large, country-scale study to ascertain the occurrence of STEMI in accordance to atmospheric features could be of interest.FundingUMIB is funded by Foundation for Science and Technology (FCT) Portugal (UID/Multi/00215/2019).Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1658436" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1473954" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1658437" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1473955" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Studied population and definitions" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Climate characteristics" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-31" "fechaAceptado" => "2020-11-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1473954" "palabras" => array:5 [ 0 => "Myocardial infarction" 1 => "Climate" 2 => "Meteorological" 3 => "Atmospheric features" 4 => "STEMI" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1473955" "palabras" => array:5 [ 0 => "Infarto do miocárdio" 1 => "Clima" 2 => "Meteorológico" 3 => "Características atmosféricas" 4 => "STEMI" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesSome atmospheric features have been linked to the triggering of myocardial infarction. Because data from the Temperate-Mediterranean is scarce, we sought to study whether meteorological parameters influence the incidence of ST-elevation myocardial infarction (STEMI) as confirmed by primary percutaneous intervention in a city with temperate weather (Porto, Portugal). MethodsRetrospective analysis of a series of STEMI-patients from January 2010 to December 2017. Temperature (T), relative humidity (RH), precipitation, and atmospheric pressure were obtained from a government-led institute. We utilized a generalized linear model (GLM) with a Poisson distribution, where a series of models with multivariable analysis were computed. The effects (GLM coefficients) are presented as excess relative risk (ERR). ResultsOne thousand and four consecutive STEMI-patients were included. The most important predictors of STEMI were Tmin two days before (for 1°C drop ERR=1.9%, p=0.009) and a 1% increase in RH three days before (EER=0.7%, p=0.006). Conversely, the same increase in RH the day before reduced the relative risk (EER=-0.6%, p=0.023). Temperature range, atmospheric pressure and precipitation had no impact on STEMI incidence. ConclusionIn a Temperate-Mediterranean city hot or cold temperature extremes, temperature drop and relative humidity had a significant impact on the occurrence of STEMI." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosAlgumas características atmosféricas relacionam-se com a ocorrência aumentada de enfarte agudo do miocárdio. Uma vez que os dados relativos a zonas mediterrâneas temperadas são pouco conhecidos, o nosso objetivo foi estudar a incidência de enfarte com elevação de ST em doentes submetidos a angioplastia primária, em relação com parâmetros atmosféricos, numa cidade de clima mediterrâneo temperado (Csb). MétodosAnálise retrospetiva de uma série de doentes com enfarte com elevação de ST tratados por angioplastia entre janeiro de 2010 e dezembro de 2017. Temperatura (T), humidade relativa (HR), precipitação e pressão atmosférica provenientes de registos do Instituto Português do Mar e da Atmosfera. Modelos de análise linear generalizada (GLM) com distribuição de Poisson foram utilizados para computar vários modelos de análise multivariada, calculando-se excesso de risco relativo (ERR) e respetivos coeficientes (GLM) para cada parâmetro atmosférico estudado. ResultadosForam incluídos 1004 doentes consecutivos. Os principais preditores da ocorrência de enfarte foram a T mínima dois dias anteriores ao evento (para 1°C de diminuição, EER=1,9%, p=0,009) e 1% de aumento da HR três dias anteriores ao evento (EER=0,7%, p=0,006). Inversamente, o mesmo aumento da HR no dia anterior ao evento diminuiu o risco (EER=-0,6%, p=0,023). Não se obtiveram resultados significativos para a precipitação ou pressão atmosférica. ConclusãoNuma cidade de clima mediterrâneo temperado sem insultos climáticos extremos, a diminuição da temperatura e o aumento da humidade relativa influenciaram a incidência de enfarte com elevação de ST." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary material to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2720 "Ancho" => 2925 "Tamanyo" => 343596 ] ] "descripcion" => array:1 [ "en" => "Monthly variation in temperature, atmospheric pressure and relative humidity and the number of events." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3507 "Ancho" => 2925 "Tamanyo" => 409791 ] ] "descripcion" => array:1 [ "en" => "Excess relative risk of ST-elevation myocardial infarction for different hazard periods before the event - same day, seven previous days and the average values for the previous seven day period - after a (a) 1°C drop in minimum temperature, (b) 1°C drop in maximum temperature, (c) 1°C drop in mean temperature, (d) 1°C increase in diurnal temperature range, (e) 1% increase in relative humidity and (f) 1 hPa increase in atmospheric pressure. Plots represent mean values and bars 95% confidence interval." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Legend: SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overall</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Summer</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fall</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Winter</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spring</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="11" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temperature (°C)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minimum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diurnal range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="11" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Precipitation (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Relative humidity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atmospheric pressure (hPa) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1009.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1009.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1008.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1013.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1008.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2823552.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of weather parameters." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Legend: CI: confidence interval; ERR: excess relative risk." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ERR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95%CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meteorological season \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(0.092) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Summer (reference)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6-45.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Winter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5-49.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7-45.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2823553.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Seasonal variation of ST-elevation myocardial infarction occurrence." ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 27381 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib0240" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Heusch" 1 => "B.J. Gersh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw180" "Revista" => array:3 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27141094" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0245" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural and unnatural triggers of myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.A. Kloner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pcad.2005.07.001" "Revista" => array:6 [ "tituloSerie" => "Prog Cardiovasc Dis" "fecha" => "2006" "volumen" => "48" "paginaInicial" => "285" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16517249" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0250" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Climate and environmental triggers of acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.J. Claeys" 1 => "S. Rajagopalan" 2 => "T.S. Nawrot" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2017" "volumen" => "38" "paginaInicial" => "955" "paginaFinal" => "960" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0255" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation of ST-segment elevation myocardial infarction to daily ambient temperature and air pollutant levels in a Japanese Nationwide Percutaneous Coronary Intervention Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Yamaji" 1 => "S. Kohsaka" 2 => "T. Morimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2016.11.041" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2017" "volumen" => "119" "paginaInicial" => "872" "paginaFinal" => "880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28089413" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0260" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immediate, lag and time window effects of meteorological factors on ST-elevation myocardial infarction incidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Ravljen" 1 => "T. Hovelja" 2 => "D. Vavpotic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/07420528.2017.1381847" "Revista" => array:6 [ "tituloSerie" => "Chronobiol Int" "fecha" => "2018" "volumen" => "35" "paginaInicial" => "63" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29111779" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0265" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Environmental triggers of acute myocardial infarction: results of a nationwide multiple-factorial population study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.J. Claeys" 1 => "S. Coenen" 2 => "C. Colpaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2143/AC.70.6.3120182" "Revista" => array:6 [ "tituloSerie" => "Acta Cardiol" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "693" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26717218" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0270" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of winter cold weather on acute myocardial infarctions in Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Vasconcelos" 1 => "E. Freire" 2 => "R. Almendra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Environ Pollut" "fecha" => "2013" "volumen" => "183" "paginaInicial" => "14" "paginaFinal" => "18" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0275" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between ambient temperature and acute myocardial infarction hospitalisations in Gothenburg, Sweden: 1985–2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Wichmann" 1 => "A. Rosengren" 2 => "K. Sjoberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "PLoS ONE" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e62059" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0280" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term effect of temperature on daily emergency visits for acute myocardial infarction with threshold temperatures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Lee" 1 => "E. Lee" 2 => "M.S. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0094070" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "e94070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24770787" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0285" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seasonal variations of weather conditions on acute myocardial infarction onset: Oita AMI Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Akioka" 1 => "K. Yufu" 2 => "Y. Teshima" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Heart Vess" "fecha" => "2019" "volumen" => "34" "paginaInicial" => "9" "paginaFinal" => "18" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0290" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term effects of temperature on hospital admissions for acute myocardial infarction: a comparison between two neighboring climate zones in Vietnam" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.A. Thu Dang" 1 => "D. Wraith" 2 => "H. Bambrick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.envres.2019.04.023" "Revista" => array:6 [ "tituloSerie" => "Environ Res" "fecha" => "2019" "volumen" => "175" "paginaInicial" => "167" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31128426" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0295" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Climatological variations in daily hospital admissions for acute coronary syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.B. Panagiotakos" 1 => "C. Chrysohoou" 2 => "C. Pitsavos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2004" "volumen" => "94" "paginaInicial" => "229" "paginaFinal" => "233" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0300" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation of atmospheric pressure changes and the occurrences of acute myocardial infarction and stroke" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.D. Houck" 1 => "J.E. Lethen" 2 => "M.W. Riggs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2005.02.042" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "45" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15979431" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0305" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Manfredini" 1 => "F. Manfredini" 2 => "B. Boari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2008.08.009" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "1097" "paginaFinal" => "1103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19931757" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0310" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)" "etal" => true "autores" => array:3 [ 0 => "B. Ibanez" 1 => "S. James" 2 => "S. Agewall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2017" "volumen" => "39" "paginaInicial" => "119" "paginaFinal" => "177" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0315" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "World map of the Köppen-Geiger climate classification updated" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Kottek" 1 => "J. Grieser" 2 => "C. Beck" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Meteorologische Zeitschrift" "fecha" => "2006" "volumen" => "15" "paginaInicial" => "259" "paginaFinal" => "263" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0320" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationships between weather and myocardial infarction: a biometeorological approach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Morabito" 1 => "P.A. Modesti" 2 => "L. Cecchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2004.12.047" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2005" "volumen" => "105" "paginaInicial" => "288" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16274770" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0325" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of climate conditions on hospital admissions for subcategories of cardiovascular diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Bijelović" 1 => "N. Dragić" 2 => "M. Bijelović" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.13075/mp.5893.00606" "Revista" => array:6 [ "tituloSerie" => "Med Pr" "fecha" => "2017" "volumen" => "68" "paginaInicial" => "189" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28345679" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0330" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term exposure to environmental parameters and onset of ST elevation myocardial infarction. The CARDIO-ARSIF registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Caussin" 1 => "S. Escolano" 2 => "H. Mustafic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2015.01.078" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2015" "volumen" => "183" "paginaInicial" => "17" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25662048" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0335" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Climate changes and ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Versaci" 1 => "G. Biondi-Zoccai" 2 => "A.D. Giudici" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2019.07.006" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2019" "volumen" => "294" "paginaInicial" => "1" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31301864" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0340" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heat waves, ambient temperature, and risk of myocardial infarction: an ecological study in the Community of Madrid" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Garcia-Lledo" 1 => "S. Rodriguez-Martin" 2 => "A. Tobias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Rev Esp Cardiol (Engl Ed)" "fecha" => "2019" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0345" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Climate changes and ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Versaci" 1 => "G. Biondi-Zoccai" 2 => "A.D. Giudici" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2019.07.006" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2019" "volumen" => "294" "paginaInicial" => "1" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31301864" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0350" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Influence of weather in the incidence of acute myocardial infarction in Galicia (Spain)]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Fernandez-Garcia" 1 => "O. Dosil Diaz" 2 => "J.J. Taboada Hidalgo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2015" "volumen" => "145" "paginaInicial" => "97" "paginaFinal" => "101" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0355" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Yang" 1 => "M. Zhou" 2 => "C.-Q. Ou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.envpol.2017.02.020" "Revista" => array:6 [ "tituloSerie" => "Environ Pollut" "fecha" => "2017" "volumen" => "224" "paginaInicial" => "400" "paginaFinal" => "406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28222981" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0360" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of ambient temperature, humidity, and other meteorological variables on hospital admissions for angina pectoris" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.G. Abrignani" 1 => "S. Corrao" 2 => "G.B. Biondo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1741826711402741" "Revista" => array:6 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2012" "volumen" => "19" "paginaInicial" => "342" "paginaFinal" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450571" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0365" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of climatic variables on acute myocardial infarction hospital admissions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.G. Abrignani" 1 => "S. Corrao" 2 => "G.B. Biondo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2008.06.036" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2009" "volumen" => "137" "paginaInicial" => "123" "paginaFinal" => "129" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18694607" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0370" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute effects of exposure to cold on blood pressure, platelet function and sympathetic nervous activity in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Kawahara" 1 => "H. Sano" 2 => "H. Fukuzaki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Hypertens" "fecha" => "1989" "volumen" => "2" "paginaInicial" => "724" "paginaFinal" => "726" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0375" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart rate in the pathophysiology of coronary blood flow and myocardial ischaemia: benefit from selective bradycardic agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Heusch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bjp.0707673" "Revista" => array:6 [ "tituloSerie" => "Br J Pharmacol" "fecha" => "2008" "volumen" => "153" "paginaInicial" => "1589" "paginaFinal" => "1601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18223669" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0380" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cross-sectional analysis of the relationship between home blood pressure and indoor temperature in winter: a Nationwide Smart Wellness Housing Survey in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Umishio" 1 => "T. Ikaga" 2 => "K. Kario" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/HYPERTENSIONAHA.119.12914" "Revista" => array:6 [ "tituloSerie" => "Hypertension" "fecha" => "2019" "volumen" => "74" "paginaInicial" => "756" "paginaFinal" => "766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31446802" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0385" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weather-related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.A. Modesti" 1 => "M. Morabito" 2 => "I. Bertolozzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.HYP.0000199192.17126.d4" "Revista" => array:6 [ "tituloSerie" => "Hypertension" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "155" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16380524" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0390" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of weather conditions on the frequent onset of acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Honda" 1 => "K. Fujimoto" 2 => "Y. Miyao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jjcc.2015.02.013" "Revista" => array:6 [ "tituloSerie" => "J Cardiol" "fecha" => "2016" "volumen" => "67" "paginaInicial" => "42" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25868809" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0395" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Environmental triggers of acute myocardial infarction: results of a nationwide multiple-factorial population study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.J. Claeys" 1 => "S. Coenen" 2 => "C. Colpaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2143/AC.70.6.3120182" "Revista" => array:6 [ "tituloSerie" => "Acta Cardiol" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "693" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26717218" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0400" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W.R. Keatinge" 1 => "S.R. Coleshaw" 2 => "F. Cotter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br Med J (Clin Res Ed)" "fecha" => "1984" "volumen" => "289" "paginaInicial" => "1405" "paginaFinal" => "1408" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0405" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seasonal variation in serum cholesterol levels: treatment implications and possible mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.S. Ockene" 1 => "D.E. Chiriboga" 2 => "E.J.3rd Stanek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.164.8.863" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2004" "volumen" => "164" "paginaInicial" => "863" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15111372" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0410" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Rosengren" 1 => "S. Hawken" 2 => "S. Ounpuu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet (London, England)" "fecha" => "2004" "volumen" => "364" "paginaInicial" => "953" "paginaFinal" => "962" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0415" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths. A 10-year survey: the Lille-World Health Organization MONICA project (Monitoring trends and determinants in cardiovascular disease)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Danet" 1 => "F. Richard" 2 => "M. Montaye" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.100.1.e1" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1999" "volumen" => "100" "paginaInicial" => "E1" "paginaFinal" => "E7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10393689" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0420" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Bhaskaran" 1 => "B. Armstrong" 2 => "S. Hajat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.e8556" "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2012" "volumen" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23262568" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0425" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of heat waves on mortality in susceptible groups: a cohort study of a mediterranean and a northern European City" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Oudin Åström" 1 => "P. Schifano" 2 => "F. Asta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Environ Health" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "30" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0430" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.A. Spencer" 1 => "R.J. Goldberg" 2 => "R.C. Becker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0735-1097(98)00098-9" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1998" "volumen" => "31" "paginaInicial" => "1226" "paginaFinal" => "1233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9581712" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0435" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet (London, England)" "fecha" => "1997" "volumen" => "349" "paginaInicial" => "1341" "paginaFinal" => "1346" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0440" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can ultra short-term changes in ambient temperature trigger myocardial infarction?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.T. Rowland" 1 => "A.K. Boehme" 2 => "J. Rush" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.envint.2020.105910" "Revista" => array:5 [ "tituloSerie" => "Environ Int" "fecha" => "2020" "volumen" => "143" "paginaInicial" => "105910" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32622116" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0445" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of ambient temperature on myocardial infarction: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Z. Sun" 1 => "C. Chen" 2 => "D. Xu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.envpol.2018.06.045" "Revista" => array:6 [ "tituloSerie" => "Environ Pollut" "fecha" => "2018" "volumen" => "241" "paginaInicial" => "1106" "paginaFinal" => "1114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30029319" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0450" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temperature, temperature extremes, and mortality: a study of acclimatisation and effect modification in 50 US cities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Medina-Ramón" 1 => "J. Schwartz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Occup Environ Med" "fecha" => "2007" "volumen" => "64" "paginaInicial" => "827" "paginaFinal" => "833" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0455" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Humidity may modify the relationship between temperature and cardiovascular mortality in Zhejiang Province, China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Zeng" 1 => "X. Zhang" 2 => "J. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/ijerph14080862" "Revista" => array:4 [ "tituloSerie" => "Int J Environ Res Public Health" "fecha" => "2017" "volumen" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28763041" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0460" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Humidity plays an important role in the PM2.5 pollution in Beijing" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Cheng" 1 => "K.B. He" 2 => "Z.Y. Du" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.envpol.2014.11.028" "Revista" => array:6 [ "tituloSerie" => "Environ Pollut" "fecha" => "2015" "volumen" => "197" "paginaInicial" => "68" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25497308" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0465" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between PM2.5 and risk of hospitalization for myocardial infarction: a systematic review and a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Z. Farhadi" 1 => "H. Abulghasem Gorgi" 2 => "H. Shabaninejad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12889-020-8262-3" "Revista" => array:5 [ "tituloSerie" => "BMC Public Health" "fecha" => "2020" "volumen" => "20" "paginaInicial" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32164596" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0470" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of environmental pollution and weather changes on the incidence of ST-elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Biondi-Zoccai" 1 => "G. Frati" 2 => "A. Gaspardone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2047487320928450" "Revista" => array:2 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2020" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004100000001/v1_202202030626/S087025512100456X/v1_202202030626/en/main.assets" "Apartado" => array:4 [ "identificador" => "92834" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004100000001/v1_202202030626/S087025512100456X/v1_202202030626/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025512100456X?idApp=UINPBA00004E"]

Estatísticas

Original Article

Características atmosféricas e risco de enfarte com elevação de ST no Porto (Portugal) – uma cidade com clima mediterrâneo temperado (Csb)

Susete Vieiraa, Mariana Santosa, Rui Magalhãesa, Marta Oliveirab, Ricardo Costab, Bruno Brochadoa,b, Raquel B. Santosa,b, João Silveiraa,b, Severo Torresa,b, André Luza,b,c,

Autor para correspondência

andrecoimbraluz@hotmail.com

Corresponding author.

a ICBAS School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal

b Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal

c Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal

Lido

3078

Vezes
que se leu este artigo

1181

Total PDF

1897

Total HTML

Compartilhar estatísticas

 array:24 [
  "pii" => "S087025512100456X"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2020.11.015"
  "estado" => "S300"
  "fechaPublicacion" => "2022-01-01"
  "aid" => "1857"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2021"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2022;41:51-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0870255121004601"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2021.11.004"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "1861"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2022;41:59-60"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
      "titulo" => "Exposome and cardiometabolic health&#58; Temperature change and humidity are part of the puzzle"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "59"
          "paginaFinal" => "60"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Expossoma e a sa&#250;de cardiometab&#243;lica&#58; mudan&#231;as de temperatura e de humidade s&#227;o partes do quebra-cabe&#231;a"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Claudio Tinoco Mesquita, Fernanda Azevedo-Silva"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Claudio"
              "apellidos" => "Tinoco Mesquita"
            ]
            1 => array:2 [
              "nombre" => "Fernanda"
              "apellidos" => "Azevedo-Silva"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004601?idApp=UINPBA00004E"
    "url" => "/08702551/0000004100000001/v1_202202030626/S0870255121004601/v1_202202030626/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0870255121004595"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2021.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "1860"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2022;41:49-50"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
      "titulo" => "Pregnancy and electrocardiogram&#58; Can a basic tool help us to understand a complex and understudied population&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "49"
          "paginaFinal" => "50"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Gravidez e ECG&#58; poder&#225; uma ferramenta b&#225;sica ajudar a compreender uma popula&#231;&#227;o complexa e subestudada&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Andr&#233; Viveiros Monteiro"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Andr&#233; Viveiros"
              "apellidos" => "Monteiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004595?idApp=UINPBA00004E"
    "url" => "/08702551/0000004100000001/v1_202202030626/S0870255121004595/v1_202202030626/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Atmospheric features and risk of ST-elevation myocardial infarction in Porto &#40;Portugal&#41;&#58; A temperate Mediterranean &#40;Csb&#41; city"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "51"
        "paginaFinal" => "58"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Susete Vieira, Mariana Santos, Rui Magalh&#227;es, Marta Oliveira, Ricardo Costa, Bruno Brochado, Raquel B&#46; Santos, Jo&#227;o Silveira, Severo Torres, Andr&#233; Luz"
        "autores" => array:10 [
          0 => array:3 [
            "nombre" => "Susete"
            "apellidos" => "Vieira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mariana"
            "apellidos" => "Santos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Rui"
            "apellidos" => "Magalh&#227;es"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Marta"
            "apellidos" => "Oliveira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Costa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Bruno"
            "apellidos" => "Brochado"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Raquel B&#46;"
            "apellidos" => "Santos"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Jo&#227;o"
            "apellidos" => "Silveira"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Severo"
            "apellidos" => "Torres"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          9 => array:4 [
            "nombre" => "Andr&#233;"
            "apellidos" => "Luz"
            "email" => array:1 [
              0 => "andrecoimbraluz@hotmail.com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "ICBAS School of Medicine and Biomedical Sciences&#44; University of Porto &#40;ICBAS-UP&#41;&#44; Porto&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiology Service&#44; Centro Hospitalar Universit&#225;rio do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Endocrine&#44; Cardiovascular &#38; Metabolic Research&#44; Unit for Multidisciplinary Research in Biomedicine &#40;UMIB&#41;&#44; University of Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Caracter&#237;sticas atmosf&#233;ricas e risco de enfarte com eleva&#231;&#227;o de ST no Porto &#40;Portugal&#41; &#8211; uma cidade com clima mediterr&#226;neo temperado &#40;Csb&#41;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2720
            "Ancho" => 2925
            "Tamanyo" => 343596
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Monthly variation in temperature&#44; atmospheric pressure and relative humidity and the number of events&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The pathophysiology of an ST-elevation myocardial infarction &#40;STEMI&#41; usually begins with a rupture or erosion of an atherosclerotic plaque followed by coronary spasm and the activation of both platelets and coagulation cascade&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">1</span></a> This leads to thrombus formation and to a sudden obstruction of a coronary artery culminating in myocardial necrosis&#46; To salvage the myocardium&#44; immediate recanalization is warranted&#44; preferably by a primary percutaneous coronary intervention &#40;PCI&#41;&#46; Aside from traditional cardiovascular risk factors which are related to atherosclerosis and hence to a heightened risk of a major coronary event&#44; the exact trigger associated with the onset of a STEMI is not always evident&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a> In the past few years&#44; epidemiological studies have shown that some chronobiological and environmental parameters such as pollution&#44; abrupt changes in air temperature&#44; relative humidity&#44; rainfall&#44; and atmospheric pressure have been related to an increased incidence of STEMI&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#8211;7</span></a> In Portugal&#44; a study of two major cities showed an association between temperature fall and hospital admissions for myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a> Although the risk ratio of environmental triggers to the onset of myocardial infarction has been reported to be small&#44; it exposes the entire population on a continuous and involuntary basis&#46; By addressing its putative relationship&#44; health authorities can be alerted regarding an expected rise in the incidence of STEMI&#46; Since many of the robust data come from latitudes that have particular climatic features&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">4&#44;8&#8211;11</span></a> there is a paucity of data regarding its impact in a temperate Mediterranean region&#46; Furthermore&#44; many reports capture either a broad definition of myocardial infarction&#44;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">12&#44;13</span></a> or sometimes its diagnosis comes from an administrative codification without having confirmation via PCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;14</span></a> This may have led to ascertainment bias&#46; With this study&#44; we sought to assess the impact of atmospheric parameters on the incidence of STEMI in a population who underwent PCI&#44; attended by a tertiary care center in the city of Porto&#44; Portugal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Studied population and definitions</span><p id="par0010" class="elsevierStylePara elsevierViewall">This study is a retrospective analysis of STEMI-patients treated with primary PCI at CHUP &#8211; Centro Hospitalar Universit&#225;rio do Porto &#8211; between 1 January 2010 and 31 December 2017&#46; STEMI-patients were diagnosed after clinical and electrocardiographic criteria as explained elsewhere&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">15</span></a> only those who were admitted to our center and who had an angiographic lesion assessed by invasive coronariography compatible with the clinical setting were considered for analysis&#46; Those who did not go to the hospital&#44; died before intervention or did not undergo PCI for any reason and hence a culprit lesion was not confirmed&#44; were excluded&#46; All STEMI-patients treated at our center were included in a prospective anonymized database where demographic&#44; clinical&#44; and procedural features were registered&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient informed consent for the current study was waived because the records were anonymized&#46; This study was approved by the local ethics committee &#40;local number 223-DEFI&#47;235-CE&#41; and was conducted in accordance with the revised Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Climate characteristics</span><p id="par0020" class="elsevierStylePara elsevierViewall">Portugal is a country in the Western Europe with a Mediterranean climate&#46; Porto is its second biggest city with a population of approximately 1&#46;7 million living in its metropolitan area &#40;approximate 2000 km<span class="elsevierStyleSup">2</span>&#41;&#46; Our PCI center covers around 400 000 inhabitants without significant meteorological disparities&#46; According to Koppen-Geiger&#44; Porto&#39;s climate is classified as a warm-summer Mediterranean climate &#40;Csb&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">16</span></a> which is characterized by a lack of mildly hot temperatures&#44; a cold and rainy winter and fall&#44; and a mild&#44; hot summer and spring&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Meteorological data was obtained from the Portuguese Institute for Sea and Atmosphere I&#46;P&#46;&#44; a government-lead institute&#44; from 2010 to 2017 &#8211; a total of 2922 days&#46; Most of the data were registered in the Pedras Rubras &#40;88&#46;4&#37; of days&#41; station and the remaining at Serra do Pilar &#40;9&#46;3&#37; of days&#41; and S&#227;o Gens &#40;2&#46;3&#37; of days&#41; stations&#46; These gather the overall meteorological conditions representative of the area covered by our center&#46; The following variables were collected&#58; atmospheric temperature &#40;expressed in &#176;C&#41; mean &#40;Tmean&#41;&#44; minimum &#40;Tmin&#41;&#44; maximum &#40;Tmax&#41;&#44; relative humidity &#40;&#37;&#44; mean&#41;&#44; rainfall &#40;expressed in mm&#59; mean&#41;&#44; atmospheric pressure &#40;expressed in hPa&#59; mean&#41;&#46; Missing values of meteorological parameters were inputted using the mean of the flanking values&#44; with exception for precipitation&#46; Because analysis with and without inputted missing values were similar&#44; the analyzed data was performed after inputted missing values&#46; Definition of seasons was used by the meteorological criteria as follows&#58; Summer includes June&#44; July and August months&#59; Fall includes September&#44; October and November&#59; Winter includes December&#44; January and February&#59; Spring includes March&#44; April and May&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with IBM SPSS Statistics &#40;v&#46;26&#41; using GLM with a Poisson distribution&#46; For ascertaining the effect of meteorological variables&#44; a series of models were considered for exposure at different hazard periods before the event - same day to previous seven days and the average values of two-day to seven-day period&#46; As the individualized cases were not used&#44; adjustment to the clinical variables from the data was not performed&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The effects &#40;GLM coefficients&#41; are presented as excess relative risk &#40;ERR&#41; for a unit drop in the temperature parameters &#8211; maximum&#44; minimum and median temperature&#46; The other meteorological parameters - diurnal temperature range &#40;DTR&#41;&#44; relative humidity&#44; precipitation and atmospheric pressure - are presented for a unit rise&#46; Univariate and multivariable analysis were computed to study independent parameters which predicted a higher risk of STEMI occurrence&#46; Statistical significance was set for a two-tailed p-value &#60;0&#46;05&#44; unadjusted for multiplicity&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Overall&#44; 1004 STEMI-patients confirmed by PCI had full data available and were included in the study &#40;mean 0&#46;3 STEMI per day&#41;&#46; Patients&#8217; mean age was 62&#46;5&#177;12&#46;9 years and 75&#37; were men&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Meteorological parameters are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; As expected&#44; summer was the hottest season and winter the coldest&#46; The rainiest seasons were fall and winter&#46; Relative humidity &#40;RH&#41; was also higher in these seasons&#44; whereas the atmospheric pressure was higher during the winter&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Monthly variation in temperature is depicted in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46; A higher number of STEMI was appreciated from October to January&#44; as well as in the months of April and May&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Although we did not encounter statistically significant seasonality&#44; we observed an increased risk ratio in fall&#44; winter and spring&#44; as compared to summer &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">We found several associations between STEMI occurrence and different temperature parameters at different hazard periods&#46; For a 1<span class="elsevierStyleHsp" style=""></span>&#176;C drop in minimum temperature &#40;Tmin&#41;&#44; at preceding two&#44; three and six days&#44; relative risk of STEMI increases 2&#46;0&#37;&#44; 1&#46;8&#37; and 1&#46;4&#37;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a> and supplemental Table 1&#41;&#46; A similar association was found when considering the mean values of Tmin in different hazard periods before the event &#40;two-day to seven-day period&#41;&#46; We also found an excess risk for each drop of 1<span class="elsevierStyleHsp" style=""></span>&#176;C in maximum temperature &#40;Tmax&#41; in the preceding two&#44; three and four days before the event &#40;ERR&#61;1&#46;3&#37;&#44; 1&#46;5&#37; and 1&#46;4&#37; respectively&#41;&#46; We observed a similar association when considering the mean values of Tmax in different hazard periods before the event &#40;three-day to seven-day period&#41;&#46; Finally&#44; a 1<span class="elsevierStyleHsp" style=""></span>&#176;C drop in Tmean in the preceding two&#44; three and four days was associated with an increase of 1&#46;7&#37;&#44; 1&#46;8&#37; and 1&#46;4&#37; in the risk of STEMI&#46; The same association was observed with a decrease in the average values of Tmean in the days before&#44; for all the hazard period considered&#58; two-day to seven-day period &#40;ERR ranging from 1&#46;5 to 1&#46;7&#37;&#41;&#46; Besides temperature&#44; we also found that for a 1&#37; increase in relative humidity three days before the event&#44; the risk of STEMI increased 0&#46;5&#37;&#46; We did not find any association between STEMI occurrence and diurnal temperature range&#44; precipitation and atmospheric pressure&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the stepwise models&#44; the most important predictors of STEMI occurrence are Tmin two days before the event &#40;ERR&#61;1&#46;9&#37;&#44; 95&#37; confidence interval &#40;CI&#41; 0&#46;5 to 3&#46;3&#37;&#44; p&#61;0&#46;009&#41; and a 1&#37; increase in relative humidity three days before the event &#40;ERR&#61;0&#46;7&#37;&#44; 95&#37;CI 0&#46;2 to 1&#46;3&#37;&#44; p&#61;0&#46;006&#41; for an excess of risk&#44; while the same increase in relative humidity one day before the event &#40;ERR&#61;-0&#46;6&#37;&#44; 95&#37;CI -1&#46;1 to -0&#46;1&#37;&#44; p&#61;0&#46;023&#41; was associated with a lower risk&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The main findings of this study are as follows&#58; &#40;1&#41; a drop in Tmin two days before the event is associated with a higher ERR&#59; &#40;2&#41; the highest RH in the previous three days is associated with a higher ERR&#44; whereas the highest RH one day before the event is associated with a lower ERR&#59; &#40;3&#41; although seasonality was not confirmed&#44; there is an higher relative risk in fall&#44; winter and spring&#44; as compared to summer&#59; &#40;4&#41; diurnal temperature range&#44; atmospheric pressure and precipitation did not show any significant impact&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Our results are aligned with most studies on this subject&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;6&#44;12&#44;17&#8211;21</span></a> At least three European studies &#40;from across Belgium&#44; Madrid&#44; and Paris areas&#41;&#44; which had also only included STEMI-patients undergoing PCI&#44; showed that a drop in temperature was related to an excess risk of STEMI&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;19&#44;21</span></a> Conversely&#44; in another European cohort &#40;Rome region&#41;&#44; a higher temperature in the summer was related to an increased risk of STEMI&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a> None of these regions have the same climatic characteristics as our city&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Close to our location&#44; two studies aimed to assess the incidence of acute cardiac disease in relation to climate changes&#46; One study came from Galicia&#44; &#40;Northern Spain&#41;&#44; where some regions share the same type of climate as Northern Portugal&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a> and aimed to assess the impact of daily meteorological parameters&#46; They failed to show a relationship between daily temperature and the incidence of a myocardial infarction&#46; The other study came from Portugal&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a> encompassing data gathered from the two major cities&#58; Lisbon &#40;which as has a Mediterranean Csa Climate&#41; and Porto&#44; and investigated the impact of cold weather on the incidence of acute myocardial infarction captured from diagnosis-related groups database &#40;Coded ICD9&#58;410&#41;&#46; They found that for every degree drop in temperature during the winter&#44; there was an increase of up to 2&#46;2&#37; &#40;95&#37; CI&#61;0&#46;9&#37;&#59; 3&#46;3&#37;&#41; in daily hospital admissions for myocardial infarction&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The strength of our study is twofold&#58; first&#44; we studied a population in a temperate Mediterranean climate living in a relatively small area without major meteorological disparities&#44; and second&#44; by only including patients presenting with an occluded coronary artery&#44; as confirmed by invasive angiography&#44; we believe the impact of climate on the incidence of an acute myocardial infarction was better ascertained&#46; By analyzing <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; a lower temperature starting in October is related to a steady rise in the number of events&#44; which then stabilizes and diminishes in the coldest months of January to March&#46; The same trend has been observed in other series&#44;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">14&#44;24</span></a> highlighting that it is probably temperature variation&#44; rather than absolute seasonal low temperature that closely relates to cardiac events&#46; This may suggest that vascular biology is more sensitive to the lowering of temperatures until it adapts&#46; According to one systematic review&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a> countries with a higher latitude have a less meaningful association between exposure to the cold and the number of events&#44; presumably because of the adaptive physiological response to lower temperatures&#44; but also by taking precautionary behavior against the cold&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Mechanisms that lead to these associations are multifactorial&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">2&#44;3&#44;26</span></a> One of the hypotheses is the cold-related activation of sympathetic nervous system&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">27</span></a> Increased levels of catecholamines lead to a higher heart rate which increases oxygen demands and also reduce the duration of diastole&#44; creating an impediment to coronary blood flow&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">28</span></a> Moreover&#44; to maintain a constant core body temperature in low temperatures&#44; vessels constrict to suppress heat dissipation&#44; which leads to higher blood pressure&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;29&#44;30</span></a> This process of vasoconstriction due to cold can also alter the arterial wall shear stress and lead to plaque rupture&#46; Nonetheless&#44; other physiological reasons were investigated to explain this association and some studies show that colder temperatures have pro-coagulant properties which may heighten the risk of myocardial infarction&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">31&#44;32</span></a> It is also plausible that the activation of the sympathetic nervous system leads to a higher production of new platelets&#44; which are more capable of aggregating and adhering to the vessel wall&#44; promoting thrombosis&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">33</span></a> Cold temperatures are also related to a higher number of respiratory infections&#44; namely influenza&#44; which has also been linked to a heightened risk of myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">26</span></a> Although some studies have shown a rise in cholesterol levels in winter which could act as a cofactor&#44; it appears that this effect may just be due to hemoconcentration&#44; and so the absolute value of cholesterol is not different from other seasons&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">34</span></a> Nevertheless&#44; it is plausible that in winter the average caloric intake is higher than in other seasons&#44; raising the risk not only attributed to a gluco-metabolic dysregulation but also to reduced physical activity and depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">35&#44;36</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Contrary to our findings&#44; some series showed that the incidence of STEMI is increased when there is a rise in temperature&#44;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">22&#44;37</span></a> especially in susceptible populations&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">38</span></a> whereas others refute any association between the incidence of STEMI and meteorological conditions&#46; These differences may be ascribed to the latitude of the country where the study was undertaken&#46; Similar to other reports&#44; in our series&#44; in the summer there was a lower relative risk compared to other seasons&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">7&#44;23&#44;26&#44;39&#44;40</span></a> We did also find an increased incidence of STEMI in the months from March to May&#46; Although we do not have a simple explanation for this&#44; it is tempting to speculate that a temperature rise may also trigger more events&#44; as was found in some European cohorts&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">22&#44;37&#44;38</span></a> Some authors have shown that hourly exposure &#40;six hours&#41; to increasing ambient temperature was associated with an excess risk of a myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">41</span></a> Since we did not capture these ultra-short variations&#44; a positive association with increasing temperature may have been missed&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">It seems that the relationship between temperature and the risk of a myocardial infarction is U-shaped&#44; influenced by both increasing and decreasing temperature&#44;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">42</span></a> followed by the observation that temperature extremes are associated with an excess in cardiac death&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">43</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Besides temperature&#44; this investigation also showed an excess risk of STEMI for a 1&#37; increase in RH three days before the event&#46; The opposite results for the same RH variation in lag three and lag one are not easy to interpret&#46; Not only does it likely reflect imbalances in core body temperature and water homeostasis&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">12</span></a> but it may also reflect the effect of unknown confounders undermining a cause and effect relationship in unidimensional appraisal&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">44</span></a> Contradictory results have been reported&#44; either increasing<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a> or decreasing<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">9</span></a> the risk for an acute coronary event for a given increase or decrease in ambient RH&#46; Interestingly&#44; one study showed that the concentrations of fine-particulate matter &#40;PM2&#46;5&#41; was dependent on RH&#44; raising the water-soluble components &#40;especially inorganic ions&#41;&#44; the water-soluble organic carbon to organic carbon ratio&#44; pointing to the formation of secondary organic aerosols&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">45</span></a> Since PM2&#46;5 has been associated with cardiovascular risk&#44; including myocardial infarction&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">46</span></a> RH may be a key factor in an increase in air pollutants such PM2&#46;5&#46; Finally&#44; differences in methods to ascertain this effect may result in conflicting results&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A relation between the atmospheric pressure and the number of events was not found&#46; This might be related to the lack of variability of this atmospheric parameter when compared to the temperature variation&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">36</span></a></p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0115" class="elsevierStylePara elsevierViewall">There are some limitations to this study&#46; One major limitation is that all STEMI-patients that died before treatment were not considered for analysis&#44; thereby not considering whether climate triggers were associated with a particularly severe and a rapidly fatal outcome&#46; Nevertheless&#44; by only addressing those who arrived at the hospital alive and who had a confirmatory PCI&#44; we may have reduced ascertainment bias&#46; Another major concern&#44; which has also been addressed in other similar studies&#44; is that the outdoor meteorological conditions may not reflect indoor and core body temperatures&#46; We did not measure air pollution&#44; which has been associated with triggering myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">47</span></a> This might have acted as a confounded factor impacting our results&#46; Finally&#44; we did not include the other two tertiary care hospitals in the same city&#44; which may also have a large group of patients sharing the same atmospheric characteristics&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">In a contemporary series of STEMI-patients treated with primary PCI&#44; climate had a significant association with STEMI incidence in a city without extreme meteorological variations&#46; A higher risk is to be expected with the lower minimum temperature two days before the event&#44; and a higher relative humidity three days before the event&#46; Conducting a large&#44; country-scale study to ascertain the occurrence of STEMI in accordance to atmospheric features could be of interest&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">UMIB is funded by <span class="elsevierStyleGrantSponsor" id="gs1">Foundation for Science and Technology &#40;FCT&#41; Portugal</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs1">UID&#47;Multi&#47;00215&#47;2019</span>&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1658436"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1473954"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1658437"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introdu&#231;&#227;o e objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1473955"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Studied population and definitions"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Climate characteristics"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-08-31"
    "fechaAceptado" => "2020-11-18"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1473954"
          "palabras" => array:5 [
            0 => "Myocardial infarction"
            1 => "Climate"
            2 => "Meteorological"
            3 => "Atmospheric features"
            4 => "STEMI"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1473955"
          "palabras" => array:5 [
            0 => "Infarto do mioc&#225;rdio"
            1 => "Clima"
            2 => "Meteorol&#243;gico"
            3 => "Caracter&#237;sticas atmosf&#233;ricas"
            4 => "STEMI"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Some atmospheric features have been linked to the triggering of myocardial infarction&#46; Because data from the Temperate-Mediterranean is scarce&#44; we sought to study whether meteorological parameters influence the incidence of ST-elevation myocardial infarction &#40;STEMI&#41; as confirmed by primary percutaneous intervention in a city with temperate weather &#40;Porto&#44; Portugal&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of a series of STEMI-patients from January 2010 to December 2017&#46; Temperature &#40;T&#41;&#44; relative humidity &#40;RH&#41;&#44; precipitation&#44; and atmospheric pressure were obtained from a government-led institute&#46; We utilized a generalized linear model &#40;GLM&#41; with a Poisson distribution&#44; where a series of models with multivariable analysis were computed&#46; The effects &#40;GLM coefficients&#41; are presented as excess relative risk &#40;ERR&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One thousand and four consecutive STEMI-patients were included&#46; The most important predictors of STEMI were Tmin two days before &#40;for 1<span class="elsevierStyleHsp" style=""></span>&#176;C drop ERR&#61;1&#46;9&#37;&#44; p&#61;0&#46;009&#41; and a 1&#37; increase in RH three days before &#40;EER&#61;0&#46;7&#37;&#44; p&#61;0&#46;006&#41;&#46; Conversely&#44; the same increase in RH the day before reduced the relative risk &#40;EER&#61;-0&#46;6&#37;&#44; p&#61;0&#46;023&#41;&#46; Temperature range&#44; atmospheric pressure and precipitation had no impact on STEMI incidence&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In a Temperate-Mediterranean city hot or cold temperature extremes&#44; temperature drop and relative humidity had a significant impact on the occurrence of STEMI&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Algumas caracter&#237;sticas atmosf&#233;ricas relacionam-se com a ocorr&#234;ncia aumentada de enfarte agudo do mioc&#225;rdio&#46; Uma vez que os dados relativos a zonas mediterr&#226;neas temperadas s&#227;o pouco conhecidos&#44; o nosso objetivo foi estudar a incid&#234;ncia de enfarte com eleva&#231;&#227;o de ST em doentes submetidos a angioplastia prim&#225;ria&#44; em rela&#231;&#227;o com par&#226;metros atmosf&#233;ricos&#44; numa cidade de clima mediterr&#226;neo temperado &#40;Csb&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise retrospetiva de uma s&#233;rie de doentes com enfarte com eleva&#231;&#227;o de ST tratados por angioplastia entre janeiro de 2010 e dezembro de 2017&#46; Temperatura &#40;T&#41;&#44; humidade relativa &#40;HR&#41;&#44; precipita&#231;&#227;o e press&#227;o atmosf&#233;rica provenientes de registos do Instituto Portugu&#234;s do Mar e da Atmosfera&#46; Modelos de an&#225;lise linear generalizada &#40;GLM&#41; com distribui&#231;&#227;o de Poisson foram utilizados para computar v&#225;rios modelos de an&#225;lise multivariada&#44; calculando-se excesso de risco relativo &#40;ERR&#41; e respetivos coeficientes &#40;GLM&#41; para cada par&#226;metro atmosf&#233;rico estudado&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 1004 doentes consecutivos&#46; Os principais preditores da ocorr&#234;ncia de enfarte foram a T m&#237;nima dois dias anteriores ao evento &#40;para 1<span class="elsevierStyleHsp" style=""></span>&#176;C de diminui&#231;&#227;o&#44; EER&#61;1&#44;9&#37;&#44; p&#61;0&#44;009&#41; e 1&#37; de aumento da HR tr&#234;s dias anteriores ao evento &#40;EER&#61;0&#44;7&#37;&#44; p&#61;0&#44;006&#41;&#46; Inversamente&#44; o mesmo aumento da HR no dia anterior ao evento diminuiu o risco &#40;EER&#61;-0&#44;6&#37;&#44; p&#61;0&#44;023&#41;&#46; N&#227;o se obtiveram resultados significativos para a precipita&#231;&#227;o ou press&#227;o atmosf&#233;rica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Numa cidade de clima mediterr&#226;neo temperado sem insultos clim&#225;ticos extremos&#44; a diminui&#231;&#227;o da temperatura e o aumento da humidade relativa influenciaram a incid&#234;ncia de enfarte com eleva&#231;&#227;o de ST&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall">The following are the supplementary material to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2720
            "Ancho" => 2925
            "Tamanyo" => 343596
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Monthly variation in temperature&#44; atmospheric pressure and relative humidity and the number of events&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 3507
            "Ancho" => 2925
            "Tamanyo" => 409791
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Excess relative risk of ST-elevation myocardial infarction for different hazard periods before the event - same day&#44; seven previous days and the average values for the previous seven day period - after a &#40;a&#41; 1<span class="elsevierStyleHsp" style=""></span>&#176;C drop in minimum temperature&#44; &#40;b&#41; 1<span class="elsevierStyleHsp" style=""></span>&#176;C drop in maximum temperature&#44; &#40;c&#41; 1<span class="elsevierStyleHsp" style=""></span>&#176;C drop in mean temperature&#44; &#40;d&#41; 1<span class="elsevierStyleHsp" style=""></span>&#176;C increase in diurnal temperature range&#44; &#40;e&#41; 1&#37; increase in relative humidity and &#40;f&#41; 1 hPa increase in atmospheric pressure&#46; Plots represent mean values and bars 95&#37; confidence interval&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Legend&#58; SD&#58; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overall</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Summer</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fall</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Winter</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spring</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Temperature &#40;&#176;C&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diurnal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Precipitation &#40;mm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Relative humidity &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Atmospheric pressure &#40;hPa&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1009&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1009&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1008&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1013&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1008&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2823552.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Description of weather parameters&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Legend&#58; CI&#58; confidence interval&#59; ERR&#58; excess relative risk&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ERR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37;CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Meteorological season</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#46;092&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Summer &#40;reference&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6-45&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Winter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5-49&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Spring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7-45&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2823553.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Seasonal variation of ST-elevation myocardial infarction occurrence&#46;</p>"
        ]
      ]
      4 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.doc"
          "ficheroTamanyo" => 27381
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:47 [
            0 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion&#58; a continual challenge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Heusch"
                            1 => "B&#46;J&#46; Gersh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehw180"
                      "Revista" => array:3 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2016"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27141094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural and unnatural triggers of myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;A&#46; Kloner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pcad.2005.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Prog Cardiovasc Dis"
                        "fecha" => "2006"
                        "volumen" => "48"
                        "paginaInicial" => "285"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16517249"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Climate and environmental triggers of acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Claeys"
                            1 => "S&#46; Rajagopalan"
                            2 => "T&#46;S&#46; Nawrot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2017"
                        "volumen" => "38"
                        "paginaInicial" => "955"
                        "paginaFinal" => "960"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation of ST-segment elevation myocardial infarction to daily ambient temperature and air pollutant levels in a Japanese Nationwide Percutaneous Coronary Intervention Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Yamaji"
                            1 => "S&#46; Kohsaka"
                            2 => "T&#46; Morimoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2016.11.041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2017"
                        "volumen" => "119"
                        "paginaInicial" => "872"
                        "paginaFinal" => "880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28089413"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immediate&#44; lag and time window effects of meteorological factors on ST-elevation myocardial infarction incidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Ravljen"
                            1 => "T&#46; Hovelja"
                            2 => "D&#46; Vavpotic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/07420528.2017.1381847"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chronobiol Int"
                        "fecha" => "2018"
                        "volumen" => "35"
                        "paginaInicial" => "63"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29111779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Environmental triggers of acute myocardial infarction&#58; results of a nationwide multiple-factorial population study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Claeys"
                            1 => "S&#46; Coenen"
                            2 => "C&#46; Colpaert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2143/AC.70.6.3120182"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Cardiol"
                        "fecha" => "2015"
                        "volumen" => "70"
                        "paginaInicial" => "693"
                        "paginaFinal" => "701"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26717218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of winter cold weather on acute myocardial infarctions in Portugal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Vasconcelos"
                            1 => "E&#46; Freire"
                            2 => "R&#46; Almendra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Environ Pollut"
                        "fecha" => "2013"
                        "volumen" => "183"
                        "paginaInicial" => "14"
                        "paginaFinal" => "18"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between ambient temperature and acute myocardial infarction hospitalisations in Gothenburg&#44; Sweden&#58; 1985&#8211;2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Wichmann"
                            1 => "A&#46; Rosengren"
                            2 => "K&#46; Sjoberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e62059"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short-term effect of temperature on daily emergency visits for acute myocardial infarction with threshold temperatures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Lee"
                            1 => "E&#46; Lee"
                            2 => "M&#46;S&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0094070"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "e94070"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24770787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal variations of weather conditions on acute myocardial infarction onset&#58; Oita AMI Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Akioka"
                            1 => "K&#46; Yufu"
                            2 => "Y&#46; Teshima"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Heart Vess"
                        "fecha" => "2019"
                        "volumen" => "34"
                        "paginaInicial" => "9"
                        "paginaFinal" => "18"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short-term effects of temperature on hospital admissions for acute myocardial infarction&#58; a comparison between two neighboring climate zones in Vietnam"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;A&#46; Thu Dang"
                            1 => "D&#46; Wraith"
                            2 => "H&#46; Bambrick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.envres.2019.04.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Res"
                        "fecha" => "2019"
                        "volumen" => "175"
                        "paginaInicial" => "167"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31128426"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Climatological variations in daily hospital admissions for acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Panagiotakos"
                            1 => "C&#46; Chrysohoou"
                            2 => "C&#46; Pitsavos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2004"
                        "volumen" => "94"
                        "paginaInicial" => "229"
                        "paginaFinal" => "233"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation of atmospheric pressure changes and the occurrences of acute myocardial infarction and stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;D&#46; Houck"
                            1 => "J&#46;E&#46; Lethen"
                            2 => "M&#46;W&#46; Riggs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2005.02.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "45"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15979431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Manfredini"
                            1 => "F&#46; Manfredini"
                            2 => "B&#46; Boari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2008.08.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "paginaInicial" => "1097"
                        "paginaFinal" => "1103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19931757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation&#58; the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology &#40;ESC&#41;"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Ibanez"
                            1 => "S&#46; James"
                            2 => "S&#46; Agewall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2017"
                        "volumen" => "39"
                        "paginaInicial" => "119"
                        "paginaFinal" => "177"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "World map of the K&#246;ppen-Geiger climate classification updated"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Kottek"
                            1 => "J&#46; Grieser"
                            2 => "C&#46; Beck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Meteorologische Zeitschrift"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "259"
                        "paginaFinal" => "263"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationships between weather and myocardial infarction&#58; a biometeorological approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Morabito"
                            1 => "P&#46;A&#46; Modesti"
                            2 => "L&#46; Cecchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2004.12.047"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2005"
                        "volumen" => "105"
                        "paginaInicial" => "288"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16274770"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of climate conditions on hospital admissions for subcategories of cardiovascular diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Bijelovi&#263;"
                            1 => "N&#46; Dragi&#263;"
                            2 => "M&#46; Bijelovi&#263;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.13075/mp.5893.00606"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Pr"
                        "fecha" => "2017"
                        "volumen" => "68"
                        "paginaInicial" => "189"
                        "paginaFinal" => "197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28345679"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short-term exposure to environmental parameters and onset of ST elevation myocardial infarction&#46; The CARDIO-ARSIF registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Caussin"
                            1 => "S&#46; Escolano"
                            2 => "H&#46; Mustafic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.01.078"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "183"
                        "paginaInicial" => "17"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25662048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Climate changes and ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Versaci"
                            1 => "G&#46; Biondi-Zoccai"
                            2 => "A&#46;D&#46; Giudici"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2019.07.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2019"
                        "volumen" => "294"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31301864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heat waves&#44; ambient temperature&#44; and risk of myocardial infarction&#58; an ecological study in the Community of Madrid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Garcia-Lledo"
                            1 => "S&#46; Rodriguez-Martin"
                            2 => "A&#46; Tobias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Esp Cardiol &#40;Engl Ed&#41;"
                        "fecha" => "2019"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Climate changes and ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Versaci"
                            1 => "G&#46; Biondi-Zoccai"
                            2 => "A&#46;D&#46; Giudici"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2019.07.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2019"
                        "volumen" => "294"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31301864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Influence of weather in the incidence of acute myocardial infarction in Galicia &#40;Spain&#41;&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Fernandez-Garcia"
                            1 => "O&#46; Dosil Diaz"
                            2 => "J&#46;J&#46; Taboada Hidalgo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2015"
                        "volumen" => "145"
                        "paginaInicial" => "97"
                        "paginaFinal" => "101"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Yang"
                            1 => "M&#46; Zhou"
                            2 => "C&#46;-Q&#46; Ou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.envpol.2017.02.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Pollut"
                        "fecha" => "2017"
                        "volumen" => "224"
                        "paginaInicial" => "400"
                        "paginaFinal" => "406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28222981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of ambient temperature&#44; humidity&#44; and other meteorological variables on hospital admissions for angina pectoris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;G&#46; Abrignani"
                            1 => "S&#46; Corrao"
                            2 => "G&#46;B&#46; Biondo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1741826711402741"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Prev Cardiol"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "342"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of climatic variables on acute myocardial infarction hospital admissions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;G&#46; Abrignani"
                            1 => "S&#46; Corrao"
                            2 => "G&#46;B&#46; Biondo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2008.06.036"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2009"
                        "volumen" => "137"
                        "paginaInicial" => "123"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18694607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute effects of exposure to cold on blood pressure&#44; platelet function and sympathetic nervous activity in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Kawahara"
                            1 => "H&#46; Sano"
                            2 => "H&#46; Fukuzaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Hypertens"
                        "fecha" => "1989"
                        "volumen" => "2"
                        "paginaInicial" => "724"
                        "paginaFinal" => "726"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart rate in the pathophysiology of coronary blood flow and myocardial ischaemia&#58; benefit from selective bradycardic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Heusch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bjp.0707673"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Pharmacol"
                        "fecha" => "2008"
                        "volumen" => "153"
                        "paginaInicial" => "1589"
                        "paginaFinal" => "1601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18223669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cross-sectional analysis of the relationship between home blood pressure and indoor temperature in winter&#58; a Nationwide Smart Wellness Housing Survey in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46; Umishio"
                            1 => "T&#46; Ikaga"
                            2 => "K&#46; Kario"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.119.12914"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2019"
                        "volumen" => "74"
                        "paginaInicial" => "756"
                        "paginaFinal" => "766"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31446802"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weather-related changes in 24-hour blood pressure profile&#58; effects of age and implications for hypertension management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Modesti"
                            1 => "M&#46; Morabito"
                            2 => "I&#46; Bertolozzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.HYP.0000199192.17126.d4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "155"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16380524"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of weather conditions on the frequent onset of acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Honda"
                            1 => "K&#46; Fujimoto"
                            2 => "Y&#46; Miyao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jjcc.2015.02.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiol"
                        "fecha" => "2016"
                        "volumen" => "67"
                        "paginaInicial" => "42"
                        "paginaFinal" => "50"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25868809"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Environmental triggers of acute myocardial infarction&#58; results of a nationwide multiple-factorial population study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Claeys"
                            1 => "S&#46; Coenen"
                            2 => "C&#46; Colpaert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2143/AC.70.6.3120182"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Cardiol"
                        "fecha" => "2015"
                        "volumen" => "70"
                        "paginaInicial" => "693"
                        "paginaFinal" => "701"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26717218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increases in platelet and red cell counts&#44; blood viscosity&#44; and arterial pressure during mild surface cooling&#58; factors in mortality from coronary and cerebral thrombosis in winter"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;R&#46; Keatinge"
                            1 => "S&#46;R&#46; Coleshaw"
                            2 => "F&#46; Cotter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br Med J &#40;Clin Res Ed&#41;"
                        "fecha" => "1984"
                        "volumen" => "289"
                        "paginaInicial" => "1405"
                        "paginaFinal" => "1408"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal variation in serum cholesterol levels&#58; treatment implications and possible mechanisms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46;S&#46; Ockene"
                            1 => "D&#46;E&#46; Chiriboga"
                            2 => "E&#46;J&#46;3rd Stanek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinte.164.8.863"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2004"
                        "volumen" => "164"
                        "paginaInicial" => "863"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15111372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries &#40;the INTERHEART study&#41;&#58; case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Rosengren"
                            1 => "S&#46; Hawken"
                            2 => "S&#46; Ounpuu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet &#40;London&#44; England&#41;"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "953"
                        "paginaFinal" => "962"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths&#46; A 10-year survey&#58; the Lille-World Health Organization MONICA project &#40;Monitoring trends and determinants in cardiovascular disease&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Danet"
                            1 => "F&#46; Richard"
                            2 => "M&#46; Montaye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.cir.100.1.e1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1999"
                        "volumen" => "100"
                        "paginaInicial" => "E1"
                        "paginaFinal" => "E7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10393689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heat and risk of myocardial infarction&#58; hourly level case-crossover analysis of MINAP database"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Bhaskaran"
                            1 => "B&#46; Armstrong"
                            2 => "S&#46; Hajat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.e8556"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2012"
                        "volumen" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23262568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of heat waves on mortality in susceptible groups&#58; a cohort study of a mediterranean and a northern European City"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Oudin &#197;str&#246;m"
                            1 => "P&#46; Schifano"
                            2 => "F&#46; Asta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Environ Health"
                        "fecha" => "2015"
                        "volumen" => "14"
                        "paginaInicial" => "30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46;A&#46; Spencer"
                            1 => "R&#46;J&#46; Goldberg"
                            2 => "R&#46;C&#46; Becker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0735-1097(98)00098-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1998"
                        "volumen" => "31"
                        "paginaInicial" => "1226"
                        "paginaFinal" => "1233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9581712"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Cold exposure and winter mortality from ischaemic heart disease&#44; cerebrovascular disease&#44; respiratory disease&#44; and all causes in warm and cold regions of Europe&#46; The Eurowinter Group"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet &#40;London&#44; England&#41;"
                        "fecha" => "1997"
                        "volumen" => "349"
                        "paginaInicial" => "1341"
                        "paginaFinal" => "1346"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can ultra short-term changes in ambient temperature trigger myocardial infarction&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;T&#46; Rowland"
                            1 => "A&#46;K&#46; Boehme"
                            2 => "J&#46; Rush"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.envint.2020.105910"
                      "Revista" => array:5 [
                        "tituloSerie" => "Environ Int"
                        "fecha" => "2020"
                        "volumen" => "143"
                        "paginaInicial" => "105910"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32622116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of ambient temperature on myocardial infarction&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Z&#46; Sun"
                            1 => "C&#46; Chen"
                            2 => "D&#46; Xu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.envpol.2018.06.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Pollut"
                        "fecha" => "2018"
                        "volumen" => "241"
                        "paginaInicial" => "1106"
                        "paginaFinal" => "1114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30029319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temperature&#44; temperature extremes&#44; and mortality&#58; a study of acclimatisation and effect modification in 50 US cities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Medina-Ram&#243;n"
                            1 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Occup Environ Med"
                        "fecha" => "2007"
                        "volumen" => "64"
                        "paginaInicial" => "827"
                        "paginaFinal" => "833"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Humidity may modify the relationship between temperature and cardiovascular mortality in Zhejiang Province&#44; China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Zeng"
                            1 => "X&#46; Zhang"
                            2 => "J&#46; Yang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/ijerph14080862"
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Environ Res Public Health"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28763041"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Humidity plays an important role in the PM2&#46;5 pollution in Beijing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46; Cheng"
                            1 => "K&#46;B&#46; He"
                            2 => "Z&#46;Y&#46; Du"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.envpol.2014.11.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Pollut"
                        "fecha" => "2015"
                        "volumen" => "197"
                        "paginaInicial" => "68"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25497308"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between PM2&#46;5 and risk of hospitalization for myocardial infarction&#58; a systematic review and a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Z&#46; Farhadi"
                            1 => "H&#46; Abulghasem Gorgi"
                            2 => "H&#46; Shabaninejad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12889-020-8262-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Public Health"
                        "fecha" => "2020"
                        "volumen" => "20"
                        "paginaInicial" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32164596"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of environmental pollution and weather changes on the incidence of ST-elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Biondi-Zoccai"
                            1 => "G&#46; Frati"
                            2 => "A&#46; Gaspardone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2047487320928450"
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur J Prev Cardiol"
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000004100000001/v1_202202030626/S087025512100456X/v1_202202030626/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "92834"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004100000001/v1_202202030626/S087025512100456X/v1_202202030626/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025512100456X?idApp=UINPBA00004E"
]

Informação do artigo

ISSN: 08702551
Idioma original: Inglês

DOI:10.1016/j.repc.2020.11.015

Dados atualizados diariamente

Ano/Mês	Html	Pdf	Total

2024 Novembro	8	11	19
2024 Outubro	207	38	245
2024 Setembro	63	27	90
2024 Agosto	173	61	234
2024 Julho	39	34	73
2024 Junho	44	26	70
2024 Maio	59	33	92
2024 Abril	48	28	76
2024 Mar�o	41	26	67
2024 Fevereiro	42	24	66
2024 Janeiro	35	39	74
2023 Dezembro	29	30	59
2023 Novembro	38	39	77
2023 Outubro	20	20	40
2023 Setembro	27	28	55
2023 Agosto	25	17	42
2023 Julho	41	9	50
2023 Junho	47	21	68
2023 Maio	46	39	85
2023 Abril	28	10	38
2023 Mar�o	33	29	62
2023 Fevereiro	20	30	50
2023 Janeiro	24	25	49
2022 Dezembro	29	31	60
2022 Novembro	41	32	73
2022 Outubro	44	41	85
2022 Setembro	28	40	68
2022 Agosto	27	37	64
2022 Julho	41	39	80
2022 Junho	49	40	89
2022 Maio	44	38	82
2022 Abril	36	36	72
2022 Mar�o	60	49	109
2022 Fevereiro	168	76	244
2022 Janeiro	169	60	229
2021 Dezembro	24	18	42

Mostrar tudo

Indexada em:

Siga-nos:

Estatísticas

Indexada em:

Siga-nos:

Estatísticas

Receba a nossa Newsletter