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.
BACKGROUND AND OBJECTIVES
Implantable cardioverter defibrillator (ICD) therapy is indicated following a myocardial infarction (MI) to curtail the risk of sudden cardiac death (SCD) in patients who are classified as high-risk, defined by a left ventricular ejection fraction (LVEF) ≤35%. The understanding of risk in patients with ischaemic injury who do not meet these criteria is limited. This study aims to assess the burden of SCD in patients' post-MI with LVEF 36-50%.
METHODS
Articles reporting mortality and SCD outcomes for participants with LVEF 36-50% post-MI without additional risk stratification or intervention were included. Medline, Embase and Cochrane databases were searched from index entries until the present. Data were synthesised using a random-effects model. Competing risk adjusted number needed to treat (NNT) for ICD implantation was calculated. This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
7435 records were identified, five studies with 9345 patients were included. The pooled annual rate of SCD in patients with LVEF 36-50% post-MI was 1.74% (95% CI 1.02 to 2.95); a higher annual rate of 6.34% was observed for LVEF≤35% (p=0.03) while a lower yearly rate of 0.55% was observed for LVEF >50% (p=0.02). The proportion of mortality due to SCD was similar across all LVEF strata (p=0.79). Very high between-study heterogeneity was observed (I2=89.9% for SCD and I2=96.8% for all-cause mortality). During exploratory modelling, the primary prevention ICD NNT for patients with LVEF 36-50% was 19 when applying the MADIT-II ICD treatment effect (HR 0.33, 95% CI 0.20 to 0.53) and extrapolation to a 5-year device lifespan.
CONCLUSION
This is the first meta-analysis reviewing post-MI patients with LVEF 36-50%. These findings highlight a clinically relevant unmet need for patients who carry a substantial burden of SCD despite being outside current ICD eligibility criteria. Further study is needed to improve risk stratification within this population and determine whether suitable intervention is beneficial.
PROSPERO REGISTRATION NUMBER
CRD42024551830.
E. Lau, Ahmed Abotabekh, Xinting Liu et al.· Heart· 0 citations
Myocardial infarction is a life-threatening condition with high mortality, which is especially important for patients over 75 years of age who have an increased risk of complications and death. Objective - to assess the incidence of in-hospital mortality and adverse cardiovascular events in patients aged over 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention. An analysis of data from a prospective registry of patients with ACS hospitalized in the vascular center based on the Alexandrovskaya City Hospital from January 2016 to November 2024 was performed. The initial sample included 14 420 cases of hospitalization, including 10 126 patients with NSTE-ACS. For the analysis, patients were stratified into four groups: 1st - up to 60 years old; 2nd - 60-74 years old; 3rd - 75-89 years old; 4th - 90 years and older. Data processing was performed using Excel, Jamovi, IBM SPSS Statistic 24, R statistical programs. Values of p<0,05 were considered statistically significant. Coronary angiography was performed in 98,6 % of patients. With increasing age, the following are noted: an increase in the proportion of women, an increase in the number of comorbidities, the Charlson comorbidity index, the number of points on the Killip, CRUSADE, GRACE scales, an increase in the number of complications and fatal outcomes. 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. The strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications. Predictors of the composite endpoint were elevated CPK-MB levels, AIM Score, and systolic blood pressure at admission. Elderly patients and long-term survivors with MI represent a high-risk group, necessitating an individualized and balanced approach at all stages of treatment. Further research is needed to determine optimal treatment strategies for non-ST-elevation ACS in older age groups.
A. Bogomolov, O. Kurochkina, K. Kozlov et al.· Advances in gerontology = Us...· 0 citations
Standard modifiable cardiovascular risk factors (SMuRFs) and non-SMuRFs are commonly used for risk stratification and therapeutic guidance after ST-elevation myocardial infarction (STEMI) in the general population. Their prognostic relevance with a potential implication for pharmacological and therapeutic management in individuals with established diabetes remains uncertain. This systematic review with meta-analysis aimed to identify prognostic factors associated with mortality in individuals with diabetes and STEMI qualifying for potential therapeutic targets. Studies evaluating prognostic factors for mortality in individuals with diabetes after STEMI were included up to May 3, 2025. Data extraction was performed independently by two reviewers. Certainty of evidence (CoE) was evaluated (GRADE). Thirty-seven studies were included, of which 25 had a high risk of bias. Mortality after STEMI in individuals with diabetes was consistently associated with non-SMuRFs (age, female sex, chronic kidney disease), acute cardiac dysfunction (Killip class III-IV, heart failure, cardiogenic shock), and atherosclerosis extent (anterior infarction, prior myocardial infarction, peripheral vascular disease). Diabetes-specific risk factors, including glycemic control parameters and insulin treatment, were also associated with increased risk of mortality (low to very low CoE). Once diabetes is established, no increased risk of mortality was observed for traditional SMuRFs, such as hypertension, smoking status, dyslipidemia, and obesity. These findings highlight 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. REGISTRATION PROSPERo: CRD42022378193.
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
Background In-hospital complications after emergency PCI in acute STEMI are important, especially newly diagnosed atrial fibrillation and are associated with hemodynamic instability, heart failure, stroke and mortality. There are complex nonlinear interactions between clinical, inflammatory, cardiac remodeling and procedural factors that traditional risk scores may not adequately capture. Thus, this study aimed to develop and validate an interpretable machine-learning model for early prediction of in-hospital NDAF in patients with acute STEMI undergoing emergency PCI. Methods From January 2021 to December 2024, this study collected data on patients with acute STEMI after emergency PCI from the five tertiary general hospitals in Chongqing. Important clinical variables were identified using the selection operator and least absolute shrinkage. Based on the area under the curve, the best predictive model was selected from eight machine learning methods. The predictive model’s results were interpreted using Shapley Additive explanations. Results Eighteen variables were chosen for model building, and a total of 154 patients with acute STEMI following emergent PCI were included. With the largest area under the curve of 0.991 (95% CI: 0.963–1), sensitivity of 0.846, specificity of 0.914, and Brier score of 0.2356, the Gradient Boosting model was selected. The Shapley value analytical framework was systematically applied to decode feature importance patterns and illuminate individual prognostic determinants Conclusion 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. The Gradient Boosting classifier achieved optimal predictive performance, highlighting its potential clinical utility for early risk stratification. By identifying high-risk individuals in advance, this model may support optimized clinical management and contribute to better prognosis in this high-risk population. Machine learning computations were implemented via a publicly accessible web server integrating the pre-trained Gradient Boosting prediction model. All analytical steps were performed following the platform’s default settings to maintain methodological standardization and reproducibility.
Y. Wang, Yuehui Yin· Frontiers in Medicine· 0 citations