What is the clinical evidence from this study?

Study design: Cohort. Population: Patients with ST-segment elevation myocardial infarction (STEMI) successfully treated with primary percutaneous coronary intervention (PCI) (n=725). Intervention: HAVOC score vs. lower HAVOC score. Primary outcome: New-onset atrial fibrillation (NOAF) during index hospitalization after primary PCI (OR 1.42, 95% CI 1.28–1.59, p=<0.001).

What question did this study set out to answer?

The aim is to investigate the association between HAVOC score and new-onset AF in STEMI patients during hospitalization.

March 2, 2026Open Access

Association Between HAVOC Score and New-Onset Atrial Fibrillation in Patients With ST-Segment Elevation Myocardial Infarction

Q: What are the key findings of this study?

Higher HAVOC scores were independently associated with a 42% increased odds (OR 1.42, 95% CI 1.28–1.59, p<0.001) of in-hospital new-onset atrial fibrillation in STEMI patients after PCI.

Q: What does this research mean for the field?

Higher HAVOC scores are independently associated with a 42% increased odds of in-hospital new-onset atrial fibrillation in STEMI patients after primary PCI. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

The aim is to investigate the association between HAVOC score and new-onset AF in STEMI patients during hospitalization.

Key Result

Higher HAVOC scores were independently associated with a 42% increased odds (OR 1.42, 95% CI 1.28–1.59, p<0.001) of in-hospital new-onset atrial fibrillation in STEMI patients after PCI.

Key Points

The aim is to investigate the association between HAVOC score and new-onset AF in STEMI patients during hospitalization.
Analyzed a cohort of STEMI patients from January 2023 to March 2025.
Performed continuous ECG monitoring for at least 72 hours post-primary PCI.
Calculated HAVOC score based on various cardiovascular risk factors.
Conducted multivariate logistic regression and RCS analysis.
Out of 725 patients, 70 (9.66%) developed new-onset AF during hospitalization.
Higher HAVOC score showed an independent association with new-onset AF (OR = 1.42).
A linear dose-response relationship was confirmed between HAVOC score and new-onset AF.
Integrating LVEF and LAD stenosis improved the HAVOC score's predictive capability.

Study Design

Type

Cohort (n=725)

Multicenter

Structured PICO

Does a higher HAVOC score predict in-hospital new-onset atrial fibrillation in patients with STEMI following primary PCI?

Population

725 patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful primary PCI, mean age 63.37, 72.97% male, single-center Chinese cohort. Key inclusion: continuous ECG monitoring for ≥72 hours post-PCI. Key exclusion: prior MI, prior AF/flutter, thyroid dysfunction, inflammatory diseases, hematological diseases, or malignant tumors.

Intervention

HAVOC score calculation (based on hypertension, age ≥75 years, valvular heart disease, peripheral vascular disease, obesity, and heart failure; excluding the coronary artery disease component)

Outcome

In-hospital new-onset atrial fibrillation (NOAF)hard clinical

Main Result

Effect estimate: OR 1.42 (95% CI 1.28–1.59)

p-value: p=<0.001

Limitations

Single-center retrospective study, with potential biases
Potential confounders like infarct size and reperfusion delay not controlled
Focus on in-hospital NOAF without long-term follow-up
Study population limited to single-center Chinese patients, limiting generalizability
AF detection limited to standard ECG and at least 72 hours monitoring, possibly under-detecting paroxysmal/subclinical AF

Abstract

Background: The HAVOC score is an emerging tool for estimating the risk of atrial fibrillation (AF), which has attracted growing interest. However, the use of the HAVOC score to predict in-hospital new-onset AF (NOAF) among patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Therefore, this study aimed to examine whether the HAVOC score is associated with NOAF during the index hospitalization following primary percutaneous coronary intervention (PCI) in patients with a STEMI. Methods: We studied a consecutive cohort of patients presenting with STEMI from January 2023 to March 2025. After primary PCI, each participant underwent continuous electrocardiogram monitoring for at least 72 hours. The HAVOC score was calculated based on hypertension, age ≥75 years, valvular heart disease, peripheral vascular disease, obesity, and heart failure. Results: In total, 725 patients were analyzed, with a mean age of 63.37 ± 13.16 years; of whom 72.97% were male. During the hospital stay, 70 patients (9.66%) experienced NOAF. Multivariate logistic regression analysis showed that the HAVOC score (odds ratio (OR) = 1.42, 95% confidence interval (CI): 1.28–1.59) was independently associated with NOAF. Restricted cubic spline (RCS) analysis revealed a linear dose–response relationship between the HAVOC score and NOAF (p for overall <0.001). Integrating left ventricular ejection fraction (LVEF) and the presence of left anterior descending artery stenosis enhanced the discriminatory ability of the HAVOC score for identifying NOAF (net reclassification index NRI = 0.353, 95% CI: 0.114–0.592; p = 0.004) and improved integrated discrimination (0.024, 95% CI: 0.006–0.041; p = 0.008). Conclusions: Higher HAVOC scores were independently linked to the occurrence of in-hospital NOAF among STEMI patients following PCI. NOAF risk increased with the HAVOC score, consistent with a linear dose–response across the score spectrum.

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