Soluble ST2 as an Independent Predictor of Post-Discharge New-Onset Atrial Fibrillation in Patients with ST-Elevation...

New-onset atrial fibrillation (NOAF) represents a significant complication following ST-elevation myocardial infarction (STEMI). Soluble suppression of tumorigenicity 2 (sST2) is a biomarker reflecting myocardial stress and fibrosis. However, its predictive value for post-discharge NOAF in STEMI patients remains inadequately characterized. This study was to investigate whether elevated sST2 levels during hospitalization independently predict post-discharge NOAF in STEMI patients.

This multicenter, prospective cohort study enrolled 648 consecutive STEMI patients. Serum sST2 concentrations were measured within 24 h of admission using ELISA. Multivariable logistic regression, receiver operating characteristic (ROC) curve analysis, and risk reclassification metrics were employed to assess sST2's predictive performance.

NOAF occurred in 56 patients (8.64%) during follow-up. Patients developing NOAF exhibited significantly higher sST2 levels compared to those without NOAF (62.84 ± 54.62 vs. 30.37 ± 34.71 ng/mL, p < 0.001). After adjusting for confounders, sST2 remained an independent predictor of NOAF (OR = 1.02, 95% CI: 1.01-1.02, p < 0.001). The area under the ROC curve for sST2 was 0.785 (95% CI: 0.723-0.848). Incorporating sST2 into the clinical model significantly improved discrimination (AUC from 0.718 to 0.810, p < 0.001) and risk reclassification (NRI = 0.084, p = 0.033; IDI = 0.047, p = 0.003). Restricted cubic spline analysis revealed a nonlinear dose-response relationship between sST2 and NOAF risk.

Elevated sST2 levels during hospitalization independently predict post-discharge NOAF in STEMI patients, offering incremental prognostic value beyond traditional risk factors.