A predictive nomogram incorporating Gensini score, left atrial diameter, serum creatinine, prognostic nutritional index, onset-to-PCI time, and TIMI flow grade demonstrated excellent discrimination for new-onset atrial fibrillation with an AUC of 0.916.
Cohort (n=268)
No
Can a nomogram incorporating clinical, echocardiographic, and procedural variables accurately predict new-onset atrial fibrillation in AMI patients post-PCI?
A novel nomogram incorporating six clinical and procedural variables showed excellent predictive accuracy for identifying AMI patients at high risk of new-onset AF within 6 months post-PCI.
Effect estimate: AUC 0.916 (95% CI 0.856-0.975)
Background Atrial fibrillation (AF) is a frequent complication in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), contributing to adverse outcomes. Early identification of individuals at high risk for post-PCI AF is crucial for tailored monitoring and intervention strategies. This study aimed to develop and validate a predictive nomogram for new-onset AF in AMI patients treated with PCI. Methods A retrospective observational cohort of 268 AMI patients undergoing PCI between January 2023 and December 2024 was analyzed. Patients were divided into AF ( n = 56) and non-AF ( n = 212) groups based on documented AF within 6 months post-PCI. Baseline clinical, echocardiographic, laboratory, and procedural variables were collected. Multivariate logistic regression was used to identify independent predictors of post-PCI AF. A nomogram was constructed based on the final model. Discriminatory performance was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using the Hosmer–Lemeshow test and internal bootstrap validation. Results Six independent predictors were identified: Gensini score, left atrial diameter, serum creatinine (SCr), prognostic nutritional index (PNI), symptom onset-to-PCI time, and post-PCI thrombolysis in myocardial infarction (TIMI) flow grade. The resulting nomogram demonstrated excellent discrimination (AUC = 0.916) and strong calibration (Hosmer–Lemeshow χ 2 = 0.967, p = 0.551; optimism-corrected C-index = 0.909). The model showed good internal validity and potential clinical utility for early risk stratification. Conclusion This study identified Gensini score, left atrial diameter, SCr, PNI, onset-to-PCI time, and final TIMI flow grade as independent predictors of post-PCI AF, and developed a nomogram with excellent predictive accuracy requiring validation in larger multicenter cohorts.
Li et al. (Tue,) conducted a cohort in Acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) (n=268). Risk factors for post-PCI atrial fibrillation (Gensini score, left atrial diameter, SCr, PNI, onset-to-PCI time, TIMI flow grade) vs. Patients without new-onset atrial fibrillation was evaluated on Discriminatory performance of the predictive nomogram for new-onset atrial fibrillation within 6 months post-PCI (AUC 0.916, 95% CI 0.856-0.975). A predictive nomogram incorporating Gensini score, left atrial diameter, serum creatinine, prognostic nutritional index, onset-to-PCI time, and TIMI flow grade demonstrated excellent discrimination for new-onset atrial fibrillation with an AUC of 0.916.