Use of the SAMe-TT2R2 Score to Predict Good Anticoagulation Control with Warfarin in Chinese Patients with Atrial Fibrillation: Relationship to Ischemic Stroke Incidence.
Use of the SAMe-TT2R2 Score to Predict Good Anticoagulation Control with Warfarin in Chinese Patients with Atrial Fibrillation: Relationship to Ischemic Stroke Incidence.
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DOI：
10.1371/journal.pone.0150674
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Siu CW
中科院分区：
文献类型：
--
作者：
Chan PH;Hai JJ;Chan EW;Li WH;Tse HF;Wong IC;Lip GY;Siu CW
华法林治疗预防房颤（AF）中风的有效性和安全性取决于治疗范围内的时间（TTR）。我们的目的是评估SAMe-TT 2 R2评分对中国房颤患者华法林治疗的预测能力，其TTR是众所周知的差。这是一项单中心回顾性研究。根据SAMe-TT 2 R2评分对1997年至2011年期间确诊的接受华法林治疗的非瓣膜性AF患者进行分层，并使用Rosendaal方法计算TTR。评估了SAMe-TT 2 R2评分对良好TTR的预测能力，即>70%。我们纳入了1，428例接受华法林治疗的非瓣膜性AF中国患者（平均年龄76.2±8.7岁，47.5%为男性）。TTR的平均值和中位数分别为38.2±24.4%和38.8%（四分位距：17.9%和56.2%）。TTR随着SAMe-TT 2 R2评分的增加而进行性降低（p = 0.016）。当SAMe-TT 2 R2评分的临界值设为2时，预测TTR<70%的敏感性和特异性分别为85.7%和17.8%。相应的阳性和阴性预测值分别为10.1%和92.0%。平均随访4.7±3.6年后，338例患者发生缺血性卒中（4.96%/年）。TTR≥70%的患者缺血性卒中的年风险为3.67%/年，低于TTR<70%的患者（5.13%/年）（p = 0.08）。与SAMe-TT 2 R2评分= 3（4.56%/年）和SAMe-TT 2 R2评分≥4（6.41%/年）的患者相比，SAMe-TT 2 R2评分≤2的患者的缺血性卒中年风险最低（3.49%/年）（p<0.001）。随着SAMe-TT 2 R2评分的增加，颅内出血也有增加的非显著趋势。在中国AF患者中，SAMe-TT 2 R2评分与TTR具有良好的相关性，评分>2具有高灵敏度和不良TTR的阴性预测值。缺血性卒中风险随着SAMe-TT 2 R2评分的增加而逐渐增加，这与SAMe-TT 2 R2评分高时TTR较差一致。
The efficacy and safety of warfarin therapy for stroke prevention in atrial fibrillation (AF) depends on the time in therapeutic range (TTR). We aimed to assess the predictive ability of SAMe-TT2R2 score in Chinese AF patients on warfarin, whose TTR is notoriously poor. This is a single-centre retrospective study. Patients with non-valvular AF on warfarin diagnosed between 1997 and 2011 were stratified according to SAMe-TT2R2 score, and TTR was calculated using Rosendaal method. The predictive power of SAMe-TT2R2 scores for good TTR i.e. >70% was assessed. We included 1,428 Chinese patients (mean age 76.2±8.7 years, 47.5% male) with non-valvular AF on warfarin. The mean and median TTR were 38.2±24.4% and 38.8% (interquartile range: 17.9% and 56.2%) respectively. TTR decreased progressively with increasing SAMe-TT2R2 score (p = 0.016). When the cut-off value of SAMe-TT2R2 score was set to 2, the sensitivity and specificity to predict TTR<70% were 85.7% and 17.8%, respectively. The corresponding positive and negative predictive values were 10.1% and 92.0%. After a mean follow-up of 4.7±3.6 years, 338 patients developed an ischemic stroke (4.96%/year). Patients with TTR≥70% had a lower annual risk of ischemic stroke of 3.67%/year compared with than those with TTR<70% (5.13%/year)(p = 0.08). Patients with SAMe-TT2R2 score ≤2 had the lowest risk of annual risk of ischemic stroke (3.49%/year) compared with those with SAMe-TT2R2 score = 3 (4.56%/year), and those with SAMe-TT2R2 score ≥4 (6.41%/year)(p<0.001). There was also a non-significant trend towards more intracranial hemorrhage with increasing SAMe-TT2R2 score. The SAMe-TT2R2 score correlates well with TTR in Chinese AF patients, with a score >2 having high sensitivity and negative predictive values for poor TTR. Ischemic stroke risk increased progressively with increasing SAMe-TT2R2 score, consistent with poorer TTRs at high SAMe-TT2R2 scores.