Association between the Osaka Prognostic Score and new-onset atrial fibrillation after primary percutaneous coronary intervention for STEMI

Aims: New-onset atrial fibrillation (NOAF) is a common complication of ST-segment elevation myocardial infarction (STEMI) and is associated with adverse clinical outcomes. The Osaka Prognostic Score (OPS), a composite index incorporating C-reactive protein, albumin, and lymphocyte count, reflects systemic inflammation and nutritional status. This study investigated the association between OPS and in-hospital NOAF in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective single-center study included consecutive STEMI patients treated with primary PCI between 2021 and 2025. Clinical, laboratory, echocardiographic, and angiographic data were collected from electronic medical records. OPS was calculated using admission laboratory parameters. Logistic regression analyses were performed to identify predictors of NOAF. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of OPS and the CHA₂DS₂-VA score. Results: Among 612 patients, NOAF developed in 41 (6.7%). Patients with NOAF were older and had a higher prevalence of hypertension, multivessel disease, larger left atrial diameter, lower left ventricular ejection fraction, and higher OPS values. In multivariable analysis, OPS remained an independent predictor of NOAF (OR: 6.57, 95% CI: 3.54-12.20, p<0.001). ROC analysis demonstrated high discriminative ability for OPS (AUC: 0.876, 95% CI: 0.831-0.918), which was superior to that of the CHA₂DS₂-VA score (AUC: 0.743, 95% CI: 0.671-0.818). Conclusion: OPS is independently associated with in-hospital NOAF in STEMI patients undergoing primary PCI and may serve as a simple and readily available tool for early risk stratification.