Analysis of accuracy of risk assessment tools for predicting new-onset atrial fibrillation in ST-elevation myocardial nfarction with percutaneous coronaty intervention (a systematic review)
Jul 2026· Siberian Journal of Clinical and Experimental Medicine· 0 citations· 40 references
TL;DR
The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia, and most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability.
Abstract
Introduction
. Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 2–4% of the adult population. Among patients with ST-elevation myocardial infarction (STEMI), the incidence of new-onset atrial fibrillation (NOAF) ranges from 4 to 28%. The development of NOAF after percutaneous coronary intervention (PCI) in STEMI patients is associated with an increased risk of hospital mortality and adverse long-term outcomes.
Aim
: To assess the prognostic performance of existing risk stratification tools for predicting NOAF in STEMI patients after PCI.
Methods
. A literature search was conducted following the PRISMA guidelines. Data from international databases, including PubMed, Web of Science, and others, published between 2020 and 2025, were analyzed. Studies addressing the prediction of NOAF developing during hospitalization in STEMI patients after PCI were included. A total of 23 articles were selected for the final analysis.
Results and Discussion
. The reported incidence of NOAF in STEMI patients after PCI ranged from 2.3% to 17%, indicating substantial variability. The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia. The predictive accuracy of existing risk scores not originally designed to assess NOAF risk (including CHA2DS2-VASc, HATCH, POAF, etc.) was insufficient, with AUC < 0.7. In contrast, most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability (AUC: 0.758–0.839). This superior performance may be explained by the inclusion of predictors reflecting systemic inflammatory response, metabolic and nutritional status, which indirectly characterize the severity of ischemic injury, myocardial remodeling, and neurohumoral imbalance associated with an increased risk of NOAF.
This is the first meta-analysis reviewing post-MI patients with LVEF 36-50 with a clinically relevant unmet need for patients who carry a substantial burden of SCD despite being outside current ICD eligibility criteria.
E. Lau, Ahmed Abotabekh, Xinting Liu et al.· Heart· 0 citations
Among patients over 75 years of age, the PCI group had a higher incidence of adverse events, total complications, and mortality compared to the conservative management group, and the strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications.
A. N. Bogomolov, O. Kurochkina, K. Kozlov et al.· Advances in gerontology = Us...· 0 citations
The need for therapeutic strategies beyond conventional risk factor modification, with emphasis on acute hemodynamic management, tailored pharmacotherapy, and optimized glycemic control in this high-risk population of individuals with established diabetes is highlighted.
R. Ipek, Edyta Schaefer, M. Neuenschwander et al.· Pharmacology and Therapeutic...· 0 citations
BACKGROUND
Atrial function plays a crucial role in patients with heart failure (HF). Recently, criteria for atrial cardiomyopathy (AtCM) have been proposed based on both electrical and mechanical atrial dysfunction. However, it is unclear whether AtCM defined by the proposed criteria can stratify the risk of adverse events in patients with HF.
OBJECTIVES
The authors sought to investigate the association between AtCM and clinical outcomes.
METHODS
Between January 2020 and June 2025, 2,046 symptomatic patients with chronic HF from a multicenter registry were prospectively enrolled. Patients who exhibited baseline electrical and mechanical atrial dysfunction on electrocardiography and echocardiography were diagnosed with AtCM. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.
RESULTS
During a median follow-up period of 727 days (IQR: 518-1,119), the primary outcome occurred in 427 patients. The incidence of the primary outcome was higher in patients with AtCM than in those without AtCM (P < 0.001). Multivariable regression analyses showed that the presence of AtCM was associated with a higher risk of the primary outcome after adjustment for prognostic covariates, including atrial fibrillation (HR: 1.31; 95% CI: 1.00-1.70). The coexistence of electrical and mechanical atrial dysfunction showed the highest risk of adverse events.
CONCLUSIONS
AtCM defined by the proposed criteria identified patients with HF at increased risk of adverse events. Combined electrical and mechanical atrial dysfunction characterized a subgroup with markedly elevated risk, underscoring the clinical relevance of integrating both domains when diagnosing AtCM. (Development of a flail evaluation application based on deep learning; UMIN000043390).
Hiroki Uehara, M. Kambayashi, Toshiyuki Nagai et al.· JACC: Advances· 0 citations
Background Atrial fibrillation (AF) is an important risk factor for ischemic stroke. However, the prognostic impact of acute atrial fibrillation (AAF) at the onset of acute ischemic stroke (AIS) remains unclear. Methods This retrospective study categorized 417 patients with AIS into the AAF (n = 72), other AF (n = 142), and non-AF (n = 203) groups. Multivariate logistic regression analysis of associations with 30-day all-cause mortality and severe early neurological deficit (7-day NIHSS ≥16). Results The AAF group demonstrated significantly worse outcomes than the other AF and non-AF groups. In the multivariable analysis, AAF was identified as an independent risk predictor for severe 7-day neurological deficit [odds ratio (OR): 10.09; 95% CI: 3.87−27.36; P < 0.001] and all-cause mortality within 30 days (OR: 4.11; 95% CI: 2.28−7.43; P < 0.001). Conclusions AAF at the onset of AIS is an independent risk predictor for early neurological deterioration and short-term mortality, establishing it as a crucial prognostic indicator that warrants vigilant management.
G. Duan, Xiaoguang Zhu, Jiangshan Deng et al.· Frontiers in Cardiovascular...· 0 citations
The present study developed and compared eight machine learning models for the prediction of in-hospital NDAF among acute patients with STEMI treated with emergency PCI and found the Gradient Boosting model achieved optimal predictive performance.
Y. Wang, Yuehui Yin· Frontiers in Medicine· 0 citations