Key result
Higher admission NLR and inflammatory markers are linked to new-onset AF after AMI.
Why the study?
New-onset atrial fibrillation complicates acute myocardial infarction and worsens prognosis, and although systemic inflammation may contribute, the value of admission inflammatory biomarkers is uncertain.
Are admission inflammatory biomarkers (NLR, PLR, CRP, hs-CRP) associated with new-onset atrial fibrillation in patients with acute myocardial infarction?
Meta-Analysis (n=12,509)
Are admission inflammatory biomarkers (NLR, PLR, CRP, hs-CRP) associated with new-onset atrial fibrillation in patients with acute myocardial infarction?
Answers are grounded in this paper and cite their sources.
Although elevated admission NLR, CRP, and hs-CRP are associated with new-onset atrial fibrillation after acute myocardial infarction, the certainty of evidence is very low and these biomarkers cannot yet be used to identify high-risk patients clinically.
Background: New-onset atrial fibrillation (NOAF) complicates acute myocardial infarction (AMI) and worsens prognosis. Systemic inflammation may contribute, but the value of admission inflammatory biomarkers is uncertain.Methods: Following PRISMA 2020 (PROSPERO CRD420261470060), we searched six databases from inception to 26 September 2026 for observational studies comparing admission neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), or high-sensitivity CRP (hs-CRP) between AMI patients with and without NOAF. Risk of bias was assessed with QUIPS and certainty of evidence with GRADE. We used random-effects models, prediction intervals, leave-one-out sensitivity analyses, and Doi plots with the LFK index.Results: Sixteen studies (12,509 patients; 1,103 with NOAF) were included. NOAF was associated with higher NLR (MD 1.78, 95% CI 0.44 to 3.11; I² 70.6%), CRP (MD 4.17, 1.42 to 6.91; I² 53.8%), and hs-CRP (SMD 0.84, 0.47 to 1.20; I² 88.6%). PLR did not differ significantly (three studies; MD 57.19, 95% CI −13.38 to 127.77). CRP and hs-CRP remained significant in every leave-one-out analysis, whereas NLR lost significance after omitting one study (p = 0.055). All prediction intervals crossed no effect. Funnel plots, Doi plots, and LFK indices (2.46 to 7.25) indicated asymmetry. Certainty of evidence was very low for all biomarkers.Conclusion: Higher admission NLR, CRP, and hs-CRP are associated with NOAF after AMI, but the evidence is very low certainty and PLR findings are inconclusive. These markers cannot yet identify individual high-risk patients; prospective studies with standardized sampling, continuous rhythm monitoring, and adjusted analyses are needed.
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Salameh et al. (2026) conducted a meta-analysis in Acute myocardial infarction (AMI) (n=12,509). Admission inflammatory biomarkers (NLR, PLR, CRP, hs-CRP) vs. AMI patients without new-onset atrial fibrillation was evaluated on Association of admission neutrophil-to-lymphocyte ratio (NLR) with new-onset atrial fibrillation (NOAF) (MD 1.78, 95% CI 0.44-3.11). Admission NLR (MD 1.78, 95% CI 0.44-3.11), CRP (MD 4.17), and hs-CRP (SMD 0.84) were higher in AMI patients with new-onset AF, though certainty was very low.
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