目的: 探讨残粒胆固醇（remnant lipoprotein cholesterol，RLP-C）、同型半胱氨酸（homocysteine，Hcy）预测老年急性心肌梗死（acute myocardial infarction，AMI）患者新发心房颤动（房颤）的价值。方法: 选择2018年1月至2023年6月廊坊市第四人民医院心内科收治住院的449例老年AMI患者为研究对象，根据住院期间是否有新发房颤分为房颤组90例和非房颤组359例。收集2组患者相关临床资料，利用Logistic回归分析新发房颤的危险因素，采用受试者操作特征（receiver operating characteristic, ROC）曲线判断各指标对新发房颤的预测效果。结果: 与非房颤组比较，房颤组入院时心率、RLP-C、Hcy水平升高（P<0.05）。2组心功能Killip分级差异有统计学意义（P<0.05）。Logistic回归分析显示，入院时心率、RLP-C、Hcy为新发房颤发生的独立危险因素（P<0.05）。ROC曲线分析显示，RLP-C、Hcy及两者联合预测老年AMI患者新发房颤的曲线下面积（area under curve, AUC）分别为0.761、0.720和0.845，RLP-C、Hcy联合预测的AUC均高于单一预测的AUC（Z=3.061、3.692，P<0.05）。结论: RLP-C、Hcy为老年AMI患者新发房颤的独立预测因子，两者联合能进一步提升预测价值。

Objective To investigate the value of remnant lipoprotein cholesterol（RLP-C）and homocysteine（Hcy）in predicting new-onset atrial fibrillation（AF） in elderly patients with acute myocardial infarction（AMI）. Methods A total of 449 elderly patients with AMI admitted to the Cardiology Department of Langfang Fourth People’s Hospital from January 2018 to June 2023 were enrolled as the research objects. The patients were divided into AF group (n=90) and non-AF group (n=359) according to the occurrence of new-onset AF during hospitalization. The clinical data of the two groups were collected. Logistic regression was used to analyze the risk factors of new-onset AF, and receiver operating characteristic (ROC) curve was used to judge the predictive effect of each index on new-onset AF. Results Compared with the non-AF group, the heart rate on admission, RLP-C and Hcy levels in the AF group were increased (P<0.05). There were significant differences in Killip grades between the two groups (P<0.05). Logistic regression analysis showed that heart rate on admission, RLP-C and Hcy were independent risk factors for new-onset AF (P<0.05). ROC curve analysis showed that the AUC of RLP-C, Hcy and their combination in predicting new-onset AF in elderly patients with AMI were 0.761, 0.720 and 0.845, respectively. The AUC of RLP-C and Hcy combined prediction was higher than that of single prediction (Z=3.061, 3.692, P<0.05). Conclusions RLP-C and Hcy are independent predictors of new-onset AF in elderly patients with AMI. The combination of RLP-C and Hcy can further improve the predictive value.