How to predict new-onset atrial fibrillation in STEMI patients treated by primary percutaneous coronary intervention: The ALBO score

Objective: Biomarkers are useful to identify individuals at risk of developing new-onset atrial fibrillation (NOAF) in patients with hypertensive cardiomyopathy and heart failure. However, few data on their prognostic value in the setting of ST-Elevation Myocardial Infarction (STEMI) are available. We aimed to develop and validate a risk score, based on common clinical risk factors, to assess the incidence of NOAF during hospitalization after primary percutaneous coronary intervention (pPCl). Methods: The risk score for NOAF occurrence during hospitalization (mean 5±6days) was developed in a cohort of 1135 consecutive STEMI patients undergoing pPCl while was externally validated in a temporal cohort of 771 STEMI patients. Biomarkers and clinical variables significantly contributing to predicting NOAF were assessed by multivariate Cox regression analysis. Results: Independent predictors of NOAF were age > 80 years |6.97 (3.40-14.30). hazard ratio (95% confidential interval), p< 0.001], leukocyte count>9.68 x 103/μL [2.65 (1.57-4.48), p80ng/L |2.37 (1.13-4.95), p = 0.02] and obesity (2.07 (1.09-3.92), p = 0.03). By summing the hazard ratios of these predictors we derived the ALBO risk score (Age, Leucocyte, BNP, Obesity) which yielded high C-statistics in both the derivation cohort (0.734 [0.675-0.793], p< 0.001) and the external validation cohort (0.76 (0.688-0.831), p < 0.001). Conclusions: The ALBO risk score, comprising biomarkers and clinical variables that can be assessed in hospital setting, could help to identify high-risk patients for NOAF after pPCl so that a prompter action can be taken.