Abstract
BACKGROUND: New-onset atrial fibrillation (NOAF) is the most commonly encountered arrhythmia during the course of acute myocardial infarction (AMI) and is independently associated with a worse prognosis. AIMS: We aimed to validate the discriminatory performance of cancer antigen-125 (CA-125) in predicting post-AMI NOAF in the Chinese population. METHODS: A total of 488 consecutive patients with AMI from 1 January 2020 to 1 January 2022 without a previous history of AF were enrolled in this study. Risk factors for post-AMI NOAF were determined using univariable and multivariable logistic regression analyses. Receiver operating characteristic (ROC) curve analyses were used to evaluate the discrimination performance of different parameters and score models. Area under the curve (AUCs) were compared using Z tests. RESULTS: In total, 48 (9.84%) patients developed post-AMI NOAF during hospitalization. The NOAF group was older and had a higher Killip class, B-type natriuretic peptide level, CA-125 level, left atrial diameter, left ventricular end-systolic diameter, CHA(2)DS(2)-VASc (Congestive heart failure, Hypertension, Age ≥75 years [2 points], Diabetes mellitus, Stroke/transient ischemic attack/thromboembolism history [2 points], Vascular disease, Age 65-74 years, Sex category [female]) score, Global Registry of Acute Coronary Events (GRACE) risk score (RS), and in-hospital mortality, and a lower low-density lipoprotein level, left ventricular ejection fraction, and initial β-receptor blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (P < 0.05 vs. the no-NOAF group for all measures). In the multivariate regression analyses, CA-125 remained an independent risk factor for post-AMI NOAF in different models. In the ROC curve analyses, CA-125 (AUC = 0.753, 95% CI: 0.665-0.84, P < 0.001), GRACE RS (AUC = 0.701, 95% CI: 0.593-0.809, P = 0.001), and CHA2DS2-VASc score (AUC = 0.644, 95% CI: 0.532-0.757, P = 0.014) were valid tools to predict post-AMI NOAF. After Z tests, the discriminatory performance of CA-125 was significantly higher than that of the CHA2DS2-VASc score (P = 0.038), but not statistically significantly higher than that of the GRACE RS (P = 0.353). CONCLUSION: An elevated plasma CA-125 level was independently associated with NOAF after AMI, with high discriminatory performance.