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To evaluate the predictive capability of SAMe-TT2R2 score in elderly patients with atrial fibrillation(AF) on warfarin anticoagulation.
Patients ≥60 years old with persistent and permanent AF on warfarin anticoagulation and monitoring INR regularly were included from clinic or hospitalized of geriatric medicine or cardiology department in Beijing Tongren Hospital during Jan 2013 to Mar 2017. Patients having rheumatic heart disease, prosthetic heart valves, hyperthyroidism or requirements for aspirin were excluded. Medical history, clinical data and INR were collected. To calculate mean INR and SAMe-TT2R2 score of each patients. INR target value was according to Chinese Expert Consensus on Management of Atrial Fibrillation in Elderly Population(2016). TTR was calculated by Rosendaal method(individual patient time in therapeutic range). Using independent-sample t test and receiver operator characteristic curve(ROC curve) to evaluate the predictive capability of SAMe-TT2R2 score in elderly patients with AF on warfarin anticoagulation.
A total of 101 patients ≥60 years old with persistent and permanent AF on warfarin anticoagulation and monitoring INR regularly were recruited, the average age was 75.69±8.51 years old, 36.6% female. The meidan of SAMe-TT2R2 score was 3 points. When 3 points, 4 points, 5 points was as the cut-off SAMe-TT2R2 score respectively, SAMe-TT2R2 score≥4 points compared with SAMe-TT2R2 score<4 points (64.93±21.25 vs 75.62±20.53, P=0.0117), SAMe-TT2R2 score≥5 points compared with SAMe-TT2R2 score<5 points (59.31±22.00 vs 72.32±20.97, P=0.0404), the level of TTR decreased. Regarding the analysis of the predictive capability of different SAMe-TT2R2 score to discriminate good or poor TTR, different cut-off of TTR was 60%, 65%, 70%, the area under ROC curve was respectively 0.6492(95%CI 0.5206-0.7778, P=0.0194), 0.6269(95%CI 0.5092-0.7446, P=0.0352), 0.6291(95%CI 0.5180-0.7402, P=0.0270). The sensitivity and specificity for 4 points as cut-off points of SAMe-TT2R2 score were relatively better than others.
Higher SAMe-TT2R2 score was associated with lower TTR level, thus SAMe-TT2R2 score had the predictive capability to predict the effect of warfarin anticoagulation. SAMe-TT2R2 score 4 points as the cut-off point for the adjustment of warfarin anticoagulation may be more matched the characteristics of elderly patients with AF in this study.