Predictive markers for new-onset atrial fibrillation in patients with non-ST-elevation acute coronary syndrome

Rubanenko O.A., Aidumova O.Yu., Rubanenko A.O.

ABSTRACT

The aim of the study is to identify markers associated with the occurrence of new-onset atrial fibrillation (AF) in a group of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).

Methods. A total of 769 patients with NSTE-ACS participated in the observational case-control study while undergoing inpatient treatment at SSMU clinics from January 1, 2019, to January 1, 2020. The results of clinical, standard laboratory, and instrumental diagnostic methods were assessed.

Results. Patients with AF were older (73.5 [66.0; 80.0] years vs. 66.0 [59.0; 73.0] years, p<0.001), had a higher incidence of prior stroke (20 [21.3%] vs. 67 [9.9%] patients, p=0.001), and chronic kidney disease (CKD) (79 [84.0%] vs. 445 [65.9%] patients, p<0.001). They also exhibited a higher heart rate (HR) (86.0 [74.0; 120.0] bpm vs. 76.0 [70.0; 86.0] bpm, p<0.001) and GRACE score (151.5 [143.0; 161.0] vs. 144.0 [134.0; 153.0], p<0.001), but a lower SYNTAX score (10.0 [4.0; 41.0] vs. 40.0 [24.0;55.0], p=0.029). Patients with AF also had higher levels of creatinine (94.0 [80.0; 113.0] μmol/l vs. 86.0 [72.0; 103.0] μmol/l, p=0.001) and glucose (8.0 [6.0; 11.0] mmol/l vs. 6.0 [6.0; 8.0] mmol/l, p=0.001), along with lower estimated glomerular filtration rate (eGFR, CKD-EPI) (58.0 [46.0; 73.0] ml/min/1.73 m² vs. 73.0 [56.0; 87.0] ml/min/1.73 m², p<0.001), total cholesterol (4.70 [3.45; 5.11] mmol/l vs. 5.00 [4.29; 6.00] mmol/l, p=0.005), and low-density lipoprotein cholesterol (2.74 [2.00; 3.30] mmol/l vs. 3.04 [2.45; 3.79] mmol/l, p=0.023). According to the echocardiographic findings, no statistically significant differences were identified. Multivariate regression analysis revealed that age (odds ratio [OR] 1.057; 95% confidence interval [CI] 1.010–1.105, p=0.016) and HR (OR 1.057; 95% CI 1.036–1.078, p<0.001) were directly associated with the occurrence of AF. The area under the ROC curve for the risk stratification of AF prognosis based on logistic regression values was 0.687 (0.028) with a 95% CI of 0.631–0.742 (p<0.001).

Conclusion. This study demonstrates that patients with AF were older, more likely to have comorbid conditions (stroke, CKD), higher HR, higher GRACE score, lower SYNTAX score, and more pronounced changes in laboratory parameters (lower eGFR, higher lipid spectrum concentrations, and glucose levels). The analysis identified age and HR as predictors of new-onset AF in patients with NSTE-ACS.

Keywords: atrial fibrillation, acute coronary syndrome, myocardial infarction, chronic kidney disease, risk factors.

For citation:

Rubanenko O.A., Aidumova O.Yu., Rubanenko  A.O. Predictive markers for new-onset atrial fibrillation in patients with non-ST-elevation acute coronary syndrome. International Journal of Heart and Vascular Diseases. 2024. 12(44): 22-28. DOI: 10.24412/2311-1623-2024-44-26-33