Association Between HAVOC Score and New-Onset Atrial Fibrillation in Patients With ST-Segment Elevation Myocardial...

The HAVOC score is an emerging tool for estimating the risk of atrial fibrillation (AF), which has attracted growing interest. However, the use of the HAVOC score to predict in-hospital new-onset AF (NOAF) among patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Therefore, this study aimed to examine whether the HAVOC score is associated with NOAF during the index hospitalization following primary percutaneous coronary intervention (PCI) in patients with a STEMI.

We studied a consecutive cohort of patients presenting with STEMI from January 2023 to March 2025. After primary PCI, each participant underwent continuous electrocardiogram monitoring for at least 72 hours. The HAVOC score was calculated based on hypertension, age ≥75 years, valvular heart disease, peripheral vascular disease, obesity, and heart failure.

In total, 725 patients were analyzed, with a mean age of 63.37 ± 13.16 years; of whom 72.97% were male. During the hospital stay, 70 patients (9.66%) experienced NOAF. Multivariate logistic regression analysis showed that the HAVOC score (odds ratio (OR) = 1.42, 95% confidence interval (CI): 1.28-1.59) was independently associated with NOAF. Restricted cubic spline (RCS) analysis revealed a linear dose-response relationship between the HAVOC score and NOAF (p for overall <0.001). Integrating left ventricular ejection fraction (LVEF) and the presence of left anterior descending artery stenosis enhanced the discriminatory ability of the HAVOC score for identifying NOAF (net reclassification index [NRI] = 0.353, 95% CI: 0.114-0.592; p = 0.004) and improved integrated discrimination (0.024, 95% CI: 0.006-0.041; p = 0.008).

Higher HAVOC scores were independently linked to the occurrence of in-hospital NOAF among STEMI patients following PCI. NOAF risk increased with the HAVOC score, consistent with a linear dose-response across the score spectrum.