Predictors of long-term atrial fibrillation following percutaneous coronary intervention in acute coronary syndrome

The development of atrial fibrillation (AF) has important prognostic implications in patients undergoing percutaneous coronary intervention (PCI), due to the concurrent need for both antiplatelet and anticoagulant therapies. This study aimed to evaluate the long-term incidence and predictors of AF in patients with acute coronary syndrome (ACS) undergoing PCI. We prospectively enrolled 337 consecutive ACS patients in sinus rhythm who underwent PCI and did not develop AF during hospitalization. Patients were followed every six months for up to 72 months. Follow-up data were available for 300 patients (89%); 37 patients were lost to follow-up. At the end of follow-up, 34 patients (11.3%) had developed AF. Kaplan-Meier analysis demonstrated that mitral annular calcification (MAC) was significantly associated with an increased incidence of AF from the early stages (χ² = 24.620, log-rank p < 0.001). Multivariate Cox regression identified body mass index (BMI) (HR: 1.070; 95% CI: 1.010-1.130; p = 0.022), left ventricular ejection fraction (LVEF) (HR: 0.942; 95% CI: 0.918-0.916; p < 0.001), mitral annular late diastolic velocity (Am) (HR: 0.785; 95% CI: 0.707-0.872; p < 0.001), and mitral annular calcification (MAC) (HR: 4.066; 95% CI: 1.976-8.368; p < 0.001) as independent predictors. These findings provide important insights into the long-term risk of AF after PCI in ACS patients and may support early identification and management of high-risk individuals.