Monocyte-to-HDL Ratio as a Predictor of New-Onset Atrial Fibrillation Following Coronary Revascularization: A Systematic Review

Abstract

Introduction Intriguingly, atrial fibrillation (AF) can be a common and severe complication after coronary revascularization and poses a high risk of stroke, heart failure, and death. A new biomarker that has come up is the Monocyte-to-HDL Ratio (MHR) that represents the balance between the inflammatory activity of the monocytes and the anti-inflammatory action of the high-density lipoprotein cholesterol (HDL-C) on the body. This is a systematic review that intends to determine the predictive role of admission MHR on new-onset atrial fibrillation (NOAF) among patients receiving percutaneous coronary intervention (PCI) or coronary artery bypass Grafting (CABG). Materials and Method: A systematic search of the PubMed, Embase, Cochrane Library and Google Scholar was performed up to early 2026. Including observations that evaluate pre-operative MHR and its correlation with NOAF in adult patients during revascularization activities was included. The Newcastle-Ottawa Scale was used to measure quality. Findings: Five studies that covered 2,565 patients were identified. NOAF occurred in a period between 5.1 and 6.4 percent in STEMI patients during the PCI intervention, 17.5 percent in elderly ACS patients and 22.8 to 23.1 percent in surgical CABG populations. In all the studies, elevated MHR was a strong independent predictor of NOAF. In PCI cohorts, the MHR predictors of NOAF such as cut-off values ranging between 15.87 and 26.54 showed significant forecasting (AUC up to 0.768). MHR was found to increase risks of arrhythmia (OR: 11.51) and was a good predictor of general mortality in CABG patients. Conclusion: MHR is a valid, economically reliable and independent biomarker in foretelling NOAF following percutaneous and surgical revascularization. The incorporation of MHR into the framework of clinical risk stratification can possibly help identify high-risk patients earlier and implement specific prophylactic interventions to enhance outcomes.