Factors associated with new-onset atrial fibrillation after coronary stent implantation: A single-center retrospective cohort study

Abstract

Background: New-onset atrial fibrillation is a clinically relevant complication that may occur after coronary stent implantation. Although several clinical and echocardiographic factors have been associated with post-procedural atrial fibrillation, the relationship between coronary anatomical disease burden and early new-onset atrial fibrillation remains incompletely characterized. Therefore, this study aimed to investigate the association between coronary anatomical disease burden and early new-onset atrial fibrillation in patients undergoing coronary stent implantation.

Methods: We retrospectively evaluated 450 patients who underwent coronary stent implantation between January 2018 and December 2025. Patients with a previous history of atrial fibrillation, permanent pacemaker implantation, moderate-to-severe valvular heart disease, or incomplete clinical data were excluded. Patients were monitored for the occurrence of documented new-onset atrial fibrillation during the seven-day observation period. Clinical, laboratory, echocardiographic, and angiographic characteristics were compared between patients who developed atrial fibrillation and those who did not. Coronary anatomical complexity was assessed using the SYNTAX score. Multivariable logistic regression analysis was performed to identify factors independently associated with new-onset atrial fibrillation.

Results: New-onset AF was documented in 37 patients (8.2%). Patients who developed AF were older and had larger left atrial diameter and higher SYNTAX scores than those without AF. In multivariable logistic regression analysis, increasing age (adjusted OR, 1.07; 95% CI, 1.03–1.11; p = 0.001), larger left atrial diameter (adjusted OR, 1.15; 95% CI, 1.07–1.24; p < 0.001), and higher SYNTAX score (adjusted OR, 1.09; 95% CI, 1.04–1.15; p < 0.001) were independently associated with new-onset AF. Given the limited number of AF events, these associations should be interpreted cautiously.

Conclusion: In this retrospective cohort of patients undergoing coronary stent implantation, older age, larger left atrial diameter, and higher SYNTAX score were independently associated with documented new-onset atrial fibrillation within seven days. These findings suggest that both atrial structural characteristics and coronary anatomical disease burden may be relevant to early post-procedural atrial fibrillation. However, the findings are exploratory and should be confirmed in larger prospective studies incorporating systematic rhythm monitoring.