# Predictive value of electrocardiogram Morphology-Voltage-P wave duration score for new episodes of atrial fibrillation in patients with acute myocardial infarction: a retrospective study

## TL;DR

A new ECG-based score called MVP can better predict new atrial fibrillation in heart attack patients than existing methods, especially for late-onset cases.

## Contribution

The MVP ECG score is introduced as a novel, non-invasive predictor of new-onset atrial fibrillation after acute myocardial infarction.

## Key findings

- The MVP score showed a graded increase in new-onset AF risk across low (11.9%), medium (28.6%), and high-risk (76.5%) groups.
- The MVP score outperformed CHA₂DS₂-VASc and C2HEST scores in predicting AF, with an AUC of 0.908 versus 0.643 and 0.715 respectively.
- The MVP score provided greater clinical benefit in identifying late-onset AF, with an AUC of 0.925.

## Abstract

The prevalence of atrial fibrillation (AF) is approximately 1.5%–2% of the general population. The Morphology-Voltage-P Wave Duration (MVP) score, a novel electrocardiographic tool based on P-wave characteristics, has shown promise in predicting AF risk. New-onset atrial fibrillation (NOAF) following acute myocardial infarction (AMI) is associated with poor clinical outcomes.

This retrospective study included 334 patients treated for AMI from January 2018 to April 2021. Patients were categorized into low-risk (202 cases), medium-risk (98 cases), and high-risk (34 cases) groups based on MVP ECG scores. NOAF incidence, stratified as early-onset (≤48 h) and late-onset (>48 h), was tracked over a 12-month follow-up period. Statistical analyses included group comparisons, Cox regression for multivariate adjustment, ROC analysis to evaluate and compare the predictive performance of the MVP score against both the CHA₂DS₂-VASc and the AF-specific C2HEST scores, and decision curve analysis (DCA) to assess clinical utility.

The MVP ECG risk score effectively predicted long-term AF incidence, showing a graded increase in risk across categories: 11.9% in low-risk, 28.6% in medium-risk, and 76.5% in high-risk patients. Incidence increased for both early-onset (4.0%, 10.2%, 29.4%) and late-onset NOAF (7.9%, 18.4%, 47.1%). The MVP score demonstrated superior discriminative ability for total NOAF (AUC = 0.908) compared to the CHA₂DS₂-VASc score (AUC = 0.643) and the C2HEST score (AUC = 0.715), with the highest performance observed for late-onset NOAF (AUC = 0.925). Addition of the MVP score to either clinical score significantly improved reclassification (NRI: 0.28–0.35, IDI: 0.07–0.08). DCA confirmed that using the MVP score provided a greater net clinical benefit than the comparator scores across realistic decision thresholds. Multivariate analysis confirmed the MVP score as an independent predictor of AF, with a stronger association for late-onset events.

The MVP ECG risk score is a simple, non-invasive tool that provides superior prediction of NOAF in AMI patients compared to traditional clinical risk scores, exhibiting particular strength in identifying patients at risk for late-onset AF. It effectively identifies high-risk patients who may benefit from close monitoring and proactive management strategies.

This retrospective study included 334 patients with acute myocardial infarction (AMI) to evaluate the Morphology-Voltage-P wave duration (MVP) ECG score as a predictor for new-onset atrial fibrillation (NOAF). Patients were stratified into low, medium, and high-risk categories based on P-wave characteristics measured at admission. Over a 12-month follow-up, the incidence of NOAF showed a significant graded increase: 11.9% in the low-risk group, 28.6% in the medium-risk group, and 76.5% in the high-risk group. The MVP score demonstrated superior discriminative ability (AUC = 0.908) compared to established clinical scores (CHA₂DS₂-VASc: AUC = 0.643; C2HEST: AUC = 0.715), exhibiting exceptional performance for predicting late-onset AF (AUC = 0.925). These findings highlight the MVP score as a simple, non-invasive tool for effective risk stratification and targeted management in post-AMI patients.

This retrospective study included 334 patients with acute myocardial infarction (AMI) to evaluate the Morphology-Voltage-P wave duration (MVP) ECG score as a predictor for new-onset atrial fibrillation (NOAF). Patients were stratified into low, medium, and high-risk categories based on P-wave characteristics measured at admission. Over a 12-month follow-up, the incidence of NOAF showed a significant graded increase: 11.9% in the low-risk group, 28.6% in the medium-risk group, and 76.5% in the high-risk group. The MVP score demonstrated superior discriminative ability (AUC = 0.908) compared to established clinical scores (CHA₂DS₂-VASc: AUC = 0.643; C2HEST: AUC = 0.715), exhibiting exceptional performance for predicting late-onset AF (AUC = 0.925). These findings highlight the MVP score as a simple, non-invasive tool for effective risk stratification and targeted management in post-AMI patients.