Predictive value of platelet-to-albumin ratio combined with the CHEST score for New-Onset atrial fibrillation in elderly patients with acute ST-segment elevation myocardial infarction.

Background: New-onset atrial fibrillation (NOAF) is a common adverse outcome in acute ST-segment elevation myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI) and is associated with a worse prognosis. The platelet-to-albumin ratio (PAR) has been utilized to predict the severity and prognosis of cardiovascular diseases. This study aims to investigate the predictive value of PAR combined with the CHEST score for NOAF in the elderly population with STEMI undergoing PCI.

Methods: 445 elderly STEMI patients without a history of atrial fibrillation (AF) who underwent PCI were consecutively enrolled in this study. Multivariate logistic regression analysis was used to identify independent risk factors for NOAF after PCI.

Results: 50 patients (11.2%) developed NOAF after PCI. Multivariate logistic regression analysis revealed that heart rate (HR), systemic immune-inflammation index (SII), uric acid (UA), PAR, and CHEST score were independent risk factors for NOAF. The area under the curve (AUC) of the combined PAR and CHEST score was 0.839, and Delong's test indicated that the combined model had superior predictive value compared to individual markers (AUC of PAR: 0.738; AUC of CHEST score: 0.752) (P < 0.05). The addition of PAR and CHEST score to this model (HR, SII, and UA) significantly improved the reclassification and discrimination ability (IDI 0.175; NRI 0.734, both P < 0.001). During regular follow-up, the incidence of MACE was higher in the NOAF group compared to the non-NOAF group.

Conclusion: The combination of PAR and the CHEST score has a high predictive value for NOAF in elderly STEMI patients following PCI.