Uric Acid-to-HDL Cholesterol Ratio as an Independent Predictor of In-Hospital New-Onset Atrial Fibrillation in Non-ST-Elevation Myocardial Infarction.

Background

To investigate the association between the uric acid-to-high-density lipoprotein cholesterol ratio (UAHDLr) and the risk of new-onset atrial fibrillation (NOAF) during hospitalization in patients with non-ST-elevation myocardial infarction (NSTEMI).

Methods

This retrospective cohort study included NSTEMI patients without prior atrial fibrillation. UAHDLr was log2-transformed to evaluate the effect of doubling. Feature selection was performed using least absolute shrinkage and selection operator regression. Cox proportional hazards models with sequential adjustments were applied. Nonlinear associations were assessed using restricted cubic spline analysis, and discrimination was evaluated with time-dependent receiver operating characteristic analysis.

Results

UAHDLr was independently associated with in-hospital NOAF across all models. Doubling (1-unit increase) UAHDLr significantly increased NOAF risk in unadjusted (HR: 5.97, 95% CI: 3.71-9.61) and clinically adjusted models (HR: 5.98, 95% CI: 3.58-9.99). The association was stronger in the LASSO-adjusted (HR: 8.19, 95% CI: 4.13-16.24) and fully adjusted models (HR: 13.40, 95% CI: 5.90-30.44). Spline analysis showed a progressive increase in NOAF risk with higher UAHDLr values. Discrimination was stable, with an area under the curve of approximately 0.76.

Conclusions

UAHDLr is a strong, easily accessible biomarker for predicting in-hospital NOAF in NSTEMI patients and may support early risk stratification.