Bryk Agata Hanna, Plens Krzysztof, Undas Anetta
Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; John Paul II Hospital, Kraków, Poland.
Cardiol J. 2017;24(5):477-483. doi: 10.5603/CJ.a2017.0038. Epub 2017 Mar 29.
The SAMe-TT2R2 (sex female, age, medical history, treatment, tobacco use, race) score was developed in patients with atrial fibrillation (AF) on warfarin. The present study aimed to 1) compare the anticoagulation quality and management of AF patients treated with warfarin with those on acenocoumarol and 2) optimize the SAMe-TT2R2 score to detect AF patients at high risk of unstable anticoagulation with acenocoumarol and warfarin.
In a single-center retrospective study, 320 patients with AF, including 15 (5%) after valve replacement, aged 40-82 (median 70) years, including 203 (63%) receiving acenocoumarol and 117 (37%) treated with warfarin, were studied. The SAMe-TT2R2 score was modified based on the candidate factors retrieved from univariate regression and assessed using the receiver operating curves (ROC).
A median SAMe-TT2R2 score was 2 (1-3). Proportions of patients with ≥ 2 points and 0-1 points in the SAMe-TT2R2 score who had the time in therapeutic range (TTR) ≤ 70% were similar (61 [67%] vs. 63 [56%], p = 0.11). A modified score, involving medical history (myocardial infarction [MI] and chronic obstructive pulmonary disease [COPD], 1 point), statin treatment (1 point) and tobacco use (2 points) had a higher area under the curve (AUC) in patients on acenocoumarol compared to SAMe- TT2R2 (0.66; 95% confidence interval 0.58-0.73 vs. 0.56; 0.48-0.64, p = 0.042); ≥ 1 point indicated TTR > 70% with a sensitivity and specificity of 61% and 63%, respectively.
The SAMe-TT2R2 score is less effective in predicting unstable anticoagulation with acenocoumarol versus warfarin. Adding statin use and highlighting COPD and previous MI increases a predictive value of this score for acenocoumarol.
SAMe-TT2R2（性别为女性、年龄、病史、治疗、吸烟情况、种族）评分是针对服用华法林的心房颤动（AF）患者制定的。本研究旨在：1）比较服用华法林与醋硝香豆素的AF患者的抗凝质量及管理情况；2）优化SAMe-TT2R2评分，以检测使用醋硝香豆素和华法林时抗凝不稳定的高危AF患者。
在一项单中心回顾性研究中，对320例AF患者进行了研究，这些患者年龄在40 - 82岁（中位数70岁），其中15例（5%）为瓣膜置换术后患者，203例（63%）接受醋硝香豆素治疗，117例（37%）接受华法林治疗。基于单因素回归得出的候选因素对SAMe-TT2R2评分进行修改，并使用受试者工作特征曲线（ROC）进行评估。
SAMe-TT2R2评分的中位数为2（1 - 3）。SAMe-TT2R2评分≥2分和0 - 1分的患者中，治疗时间在治疗范围内（TTR）≤70%的比例相似（61例[67%]对映63例[56%]，p = 0.11）。与SAMe-TT2R2相比，一项修改后的评分，包括病史（心肌梗死[MI]和慢性阻塞性肺疾病[COPD]，1分）、他汀类药物治疗（1分）和吸烟情况（2分），在服用醋硝香豆素的患者中曲线下面积（AUC）更高（0.66；95%置信区间0.58 - 0.73对映0.56；0.48 - 0.64，p = 0.042）；≥1分表明TTR > 70%，敏感性和特异性分别为61%和63%。
与华法林相比，SAMe-TT2R2评分在预测醋硝香豆素抗凝不稳定方面效果较差。增加他汀类药物使用情况并突出COPD和既往MI可提高该评分对醋硝香豆素的预测价值。
