Methavigul Komsing, Krittayaphong Rungroj
Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi 11000, Thailand.
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Asian Biomed (Res Rev News). 2025 Apr 30;19(2):106-113. doi: 10.2478/abm-2025-0013. eCollection 2025 Apr.
Previous trials have shown that the C-statistics of SAMe-TTR score in the prediction of suboptimal time in therapeutic range (TTR) is very low.
To propose the novel risk score model for predicting the poor anticoagulation control in atrial fibrillation (AF) patients compared with the SAMe-TTR score.
We prospectively recruited AF patients from 27 hospitals between 2014 and 2017 in the COOL AF Thailand registry. The poor anticoagulation control was defined as TTR <65%. Multivariate logistic regression analysis was performed for the prediction of poor anticoagulation control. The novel risk score model was then generated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the C-statistics and to compare between the novel risk score model and the SAMe-TTR score. Net Reclassification Index (NRI) and Integrated Discrimination Index (IDI) were performed.
Of 3,461 patients, 2,233 patients taking warfarin having available TTR data were retrieved. There were 1,432 patients having poor anticoagulation control (TTR < 65%) and 801 patients having good anticoagulation control (TTR ≥ 65%). Symptomatic AF, diabetes, heart failure, and a history of bleeding were associated with increased risk while obesity, AF duration, and paroxysmal AF were associated with decreased risk of poor anticoagulation control. SHOB-DAF score was created. The C-statistics of SHOB-DAF score was greater than the SAMe-TTR score (0.584 vs 0.506, < 0.001). NRI of the SHOB-DAF score was 17.82% compared with the SAMe-TTR score.
SHOB-DAF score was the novel risk score which was better than the SAMe-TTR score in predicting poor anticoagulation control.
既往试验表明，SAME-TTR评分预测治疗范围内次优时间（TTR）的C统计量非常低。
与SAME-TTR评分相比，提出用于预测心房颤动（AF）患者抗凝控制不佳的新型风险评分模型。
我们在2014年至2017年期间从泰国27家医院前瞻性招募AF患者纳入COOL AF泰国注册研究。抗凝控制不佳定义为TTR<65%。进行多因素逻辑回归分析以预测抗凝控制不佳情况。然后生成新型风险评分模型。进行受试者工作特征（ROC）曲线分析以计算C统计量，并比较新型风险评分模型和SAME-TTR评分。计算净重新分类指数（NRI）和综合鉴别指数（IDI）。
在3461例患者中，检索到2233例服用华法林且有可用TTR数据的患者。其中1432例患者抗凝控制不佳（TTR<65%），801例患者抗凝控制良好（TTR≥65%）。有症状性AF、糖尿病、心力衰竭和出血史与风险增加相关，而肥胖、AF病程和阵发性AF与抗凝控制不佳风险降低相关。创建了SHOB-DAF评分。SHOB-DAF评分的C统计量大于SAME-TTR评分（0.584对0.506，<0.001）。与SAME-TTR评分相比，SHOB-DAF评分的NRI为17.82%。
SHOB-DAF评分是一种新型风险评分，在预测抗凝控制不佳方面优于SAME-TTR评分。
