Objective To investigate the influencing factors of atrial fibrillation after off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary heart disease (CHD)

and to establish a predictive model to guide clinical intervention. Methods A total of 178 elderly patients with coronary heart disease who were treated in our hospital from January 2023 to January 2025 were prospectively selected as the research objects. All patients were treated with OPCABG. According to whether atrial fibrillation occurred within 5 days after OPCABG

they were divided into 55 cases in the occurrence group and 123 cases in the non-occurrence group. The general data of the two groups were compared

and the influencing factors of postoperative atrial fibrillation were analyzed. The prediction model was constructed

and the prediction efficiency

accuracy and clinical utility of the prediction model were evaluated by ROC curve

Hosmer-Lemeshow goodness of fit test

calibration curve and decision curve (DCA). Results Multivariate Logistic regre

ssion analysis showed that preoperative left atrial diameter

number of implanted stents

NYHA cardiac function classification

history of hypertension

moderate to severe coronary artery calcification and preoperative serum growth differentiation factor 15 (GDF-15)

galactose lectin 3 (Gal-3)

Visfatin levels were independent risk factors for postoperative atrial fibrillation (

P

<

0.05). Logit (

p

) = -0.745 + 0.868 × preoperative left atrial diameter + 1.460 × number of implanted stents + 1.575 × NYHA cardiac function classification + 1.371 × history of hypertension + 1.424 × moderate to severe coronary artery calcification + 0.771 × GDF-15 + 0.765 × Gal-3 + 0.901 × Visfatin; the AUC value of the prediction model for predicting the risk of postoperative atrial fibrillation was 0.890

the sensitivity and specificity were 85.45% and 82.93%

respectively. The prediction results of the model were in good agreement with the actual observation results

and had good clinical utility. Conclusions Preoperative left atrial diameter

number of implanted stents

NYHA cardiac function classification

history of hypertension

moderate to severe coronary artery calcification

and preoperative serum GDF-15

Gal-3

and Visfatin levels are independent risk factors for postoperative atrial fibrillation in elderly patients with coronary heart disease. Based on the above model

a prediction model was established. The model has a good predictive value for postoperative atrial fibrillation. Clinically

active intervention should be performed on the above factors to reduce postoperative atrial fibrillation.