Role of Left Atrial Volume Index and C Reactive Protein /Albumin Ratio as Predictors of New Onset Arrhythmias in ST-Elevation Myocardial Infarction Patients Treated with Percutaneous Coronary Interventions

Background: Patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) frequently experience new-onset arrhythmias, which are associated with worse outcomes. Two new indicators of arrhythmia risk are left atrial volume index (LAVI),C-reactive protein-to-albumin ratio (CAR). Their prognostic value in STEMI patients after PCI was assessed in this study. Methods: This prospective cohort study, a total of 80 consecutive patients were diagnosed with ST-elevation myocardial infarction (STEMI) were enrolled at Zagazig University Hospitals. Based on the occurrence of arrhythmias during hospitalization, patients were classified into two groups: Group I (arrhythmia group; n=35) and Group II (non-arrhythmia group; n=45). All patients underwent LAVI, which was calculated using standard techniques and indexed to body surface area (BSA). Additionally, C-reactive protein to albumin ratio (CAR) was calculated using CRP and serum albumin levels obtained upon admission, to assess systemic inflammation nutritional status. Results: Arrhythmia occurred in 35 patients (43%). LAVI, CAR were significantly higher in arrhythmia group than in non-arrhythmia group (37.1±5.6vs. 29.7±6.3mL/m², median 6.7vs. 2.7; both p<0.001). New-onset arrhythmia occurred in 35 of 80 patients (43.7%). In multivariable analysis, only heart failure independently predicted arrhythmia (adjusted OR 7.23; 95 % CI 2.29–22.84; p = 0.001). ROC analysis showed that left atrial volume index (AUC 0.81; sensitivity 71 %, specificity 82 %, CRP/albumin ratio (AUC 0.81; sensitivity 70 %, specificity 81 %, were strongest individual predictors). Conclusion: LAVI and CAR demonstrated good discriminative ability for predicting in-hospital arrhythmia after STEMI; however, only heart failure remained an independent predictor after multivariable adjustment.