The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Modified application of SAMe-TT2R2 scoring system in Asian patients with atrial fibrillation for the selection of oral anticoagulants

  • Seong Won Jeon (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Nuri Lee (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Ki Hong Lee (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Minjeong Ha (School of Materials Science and Engineering, Gwangju Institute of Science and Technology) ;
  • Changhyun Kim (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Yoo Ri Kim (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Nam Sik Yoon (Department of Internal Medicine, Chonnam National University Hospital) ;
  • Hyung Wook Park (Department of Internal Medicine, Chonnam National University Hospital)
  • Received : 2023.09.08
  • Accepted : 2023.12.13
  • Published : 2024.05.01
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Abstract

Background/Aims: The SAMe-TT2R2 score is used for assessing anticoagulation control (AC) quality with warfarin. However, it is hard to apply SAMe-TT2R2 score in Asian patients with atrial fibrillation (AF), because it has not been proven in those populations. This study aimed to validate the SAMe-TT2R2 score in Asian patients with AF and suggest a modified SAMe-TT2R2 score for this population. Methods: We analyzed 710 Korean patients with AF who were using warfarin. The AC quality was assessed as the mean time in therapeutic range (TTR). Each component of SAMe-TT2R2 score was evaluated for the relationship with AC. Further clinical factors that predict AC were analyzed. Identified factors were re-assorted and constructed as SA2Me-TTR scoring system. Results: Of the components of the SAMe-TT2R2 score, female, age, and rhythm control were associated with AC. Heart failure and renal insufficiency were newly identified factors associated with AC. The modified SA2Me-TTR score was reconstructed with the relevant risk factors (S, female gender, 1 point; A, age < 60 yr, 2 points; Me, medical history of heart failure, 1 point; T, treatment for rhythm control, 1 point; T, history of stroke or transient ischemic attack, 1 point; R, renal insufficiency, 1 point). The modified SA2Me-TTR score demonstrated an excellent relationship with the grading of AC. The modified SA2Me-TTR score ≤ 1 identified patients with good AC (hazard ratio 2.46, 95% CI 1.75-3.47). Conclusions: The modified SA2Me-TTR score was useful for guiding oral anticoagulants selection in Asian patients with AF.

Keywords

Acknowledgement

This study was supported by a grant (2021R1F1A1048115) of the National Research Foundation of Korea (NRF) funded by the Korean government (MSIT), and a CNUH-GIST research Collaboration grant (BCRI22063) funded by the Chonnam National University Hospital Biomedical Research Institute.

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