Liu Jia, Wang Nina, Qin Liuan, Liu Jun, Xi Shaozhi, Wang Xuyun, Li Xiaoqi, Zhang Yuxiao, Yin Tong
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Int J Cardiol. 2017 Aug 15;241:358-363. doi: 10.1016/j.ijcard.2017.04.092. Epub 2017 Apr 29.
The SAMe-TTR score has been proposed to predict whether patients with atrial fibrillation (AF) would be well anti-coagulated with warfarin or not. However, it might over-estimate the number of patients under suboptimal warfarin treatment in non-Caucasians. This study was designed to modify the SAMe-TTR score with genotypes and validate it in Chinese AF patients treated with warfarin.
Consented Chinese-Han patients (n=510) with AF under the treatment of warfarin for at least 3months were randomly divided into a derivation (n=310) and a validation cohort (n=200). For each patient, CYP2C9*3 and VKORC1 -1639 A/G genotyping was performed, and the time in therapeutic range (TTR) was calculated over this period.
The modified SAMe-TTR score was established by adding "warfarin genotype bins" to replace "the non-white race" variable. In the validation cohort, the discrimination performance of the modified score for good anticoagulation control (TTR≥70%) was significantly improved (c- index increased from 0.60 to 0.67). Significantly increased risks of major bleedings (HR: 4.91; 95% CI: 1.03-23.37; adjusted p=0.04) and all bleedings (HR: 1.93; 95% CI: 1.14-3.25; adjusted p=0.01) were found in patients with modified scores ≥2, as compared with patients with modified scores of 0-1.
The modified SAMe-TTR score could improve the ability for the identification of good anticoagulation control, and the prediction of major bleeding events in Chinese patients with AF treated by warfarin.
已提出使用SAMe-TTR评分来预测房颤（AF）患者使用华法林抗凝效果是否良好。然而，在非白种人中，该评分可能高估了华法林治疗效果欠佳的患者数量。本研究旨在根据基因型对SAMe-TTR评分进行修正，并在接受华法林治疗的中国房颤患者中进行验证。
同意参与研究的中国汉族房颤患者（n = 510），接受华法林治疗至少3个月，被随机分为推导队列（n = 310）和验证队列（n = 200）。对每位患者进行CYP2C9*3和VKORC1 -1639 A/G基因分型，并计算该时间段内的治疗窗时间（TTR）。
通过添加“华法林基因型分类”来替代“非白种人”变量，建立了修正的SAMe-TTR评分。在验证队列中，修正评分对良好抗凝控制（TTR≥70%）的鉴别性能显著提高（c指数从0.60增至0.67）。与修正评分为0 - 1的患者相比，修正评分≥2的患者发生大出血（HR：4.91；95% CI：1.03 - 23.37；校正p = 0.04）和所有出血事件（HR：1.93；95% CI：1.14 - 3.25；校正p = 0.01）的风险显著增加。
修正的SAMe-TTR评分可提高对华法林治疗的中国房颤患者良好抗凝控制的识别能力以及大出血事件的预测能力。
