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"Latar belakang. Penyakit Ginjal Kronik (PGK) stadium 3 merupakan faktor risiko tinggi terjadi Nefropati Akibat Kontras (NAK) setelah Percutaneous Coronary Intervention (PCI). Hidrasi merupakan salah satu modalitas mencegah NAK, demikian juga N-Acetyl Cysteine (NAC) walaupun efek proteksinya terhadap NAK masih kontroversial.Tujuan. Mengetahui apakah kombinasi hidrasi dan NAC dapat menurunkan risiko NAK pada pasien PGK stadium 3 setelah PCI pada pasien Pelayanan Jantung Terpadu (PJT) RSCM.Methoda penelitian. Studi kohort prospektif mengukur kreatinin plasma sebelum dan 48 jam sesudah PCI, sambil mencatat ada atau tidaknya perlakuan pemberian kombinasi hidrasi dan NAC pada pasien PGK stadium 3 tersebut.Hasil. Terdapat 38 pasien yang memenuhi kriteria penerimaan dan tidak mencakup kriteria penolakan serta menuntaskan penelitian dalam kurun waktu Agustus 2013 ? Januari 2014. Dua puluh tiga (43,4%) dari total 53 pasien PGK stadium 3 yang awalnya masuk studi ini diberikan perlakuan hidrasi dan NAC dan sisanya tidak mendapat perlakuan tersebut. Insidens kejadian NAK terdapat pada 2 dari 38 pasien yang menuntaskan studi (5.26%) yaitu pada kelompok yang tidak mendapat hidrasi dan NAC. Attributable Risk% sebesar 100%, kejadian NAK dapat dihilangkan 100% apabila diberikan hidrasi dan NAC.Simpulan. Kombinasi hidrasi dan NAC cenderung memproteksi kejadian NAKpada populasi PGK stadium 3 yang menjalani PCI

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Background. Stage 3 Chronic Kidney Disease (CKD) is known as a high risk factor for Contrast Induced Nephropathy (CIN) after Percutaneous Coronary Intervention (PCI). Hydration is a modality which is widely used to prevent CIN, and so is N-Acetyl Cysteine (NAC) eventhough there are controversial issues regarding their effectiveness to prevent CIN.

Aim. To know whether hydration and NAC combined has an effect of lowering CIN incidence in stage 3 CKD patients after PCI in Integrated Cardiac Services (ICS) in Cipto Mangunkusumo Hospital.

Methods. A prospective cohort is conducted examining plasma creatinine before and 48 hours after PCI in stage 3 CKD patients, meanwhile recording which patients are given combined hydration and NAC and which are not.

Results. Total 38 patients were collected whom fulfill the inclusion criteria and not meet the exclusion criteria and finished the study, from August 2013 until January 2014. Twenty-three (43,4%) of total 53 patients with stage 3 CKD whom enter the study at first were given hydration and NAC, and the did not received the combination. Incidence of CIN occurred in 2 of 38 patients whom finished this study (5.26%), all belonging to the non-hydration and NAC group. Attributable Risk% is 100%, means CIN can be 100% prevented if hydration and NAC is given.

Conclusion. Combination of Hydration and NAC is indicated to be protective against the risk of CIN in stage 3 CKD patients undergoing PCI."

"ABSTRAK Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanyalebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuahperangkat yang memiliki peran penting dalam prognosis mortalitas PJK. SkormACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.Informasi tersebut berguna dalam menentukan prioritas tindakan angiografikoroner. Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagaiprediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yangmengalami sindrom koroner akut (SKA). Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCMtahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan denganmenggunakan Receiver Operating Characteristic (ROC) curves dengan intervalkepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengancara menghitung sensitivitas, spesifisitas, RKP, dan RKN. Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%. Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGKstadium 3 dan 4 yang mengalami SKA adalah 2,288. Akurasi diagnostik skor mACEF dinilai baik.ABSTRACT Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively."

"ABSTRAKLatar Belakang. Media kontras dapat memberikan efek toksik pada sel tubulus ginjal, menyebabkan suatu kondisi dinamakan contrast induced nephropathy (CIN), yang berhubungan dengan peningkatan morbiditas dan mortalitas, dan memiliki efek yang sama pada pasien dengan gagal ginjal kronik maupun pasien risiko rendah (Laju Filtrasi Glomerolus (LFG) ≥ 60, skor Mehran sebelum tindakan ≤ 5). Dari beberapa penelitian mengenai rasio volume kontras dengan laju filtrasi glomerulus (V/LFG) untuk memprediksi CIN belum ada yang dikhususkan untuk pasien risiko rendah.Metodologi. Penelitian ini merupakan studi potong lintang yang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular FKUI/Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) dengan mengambil data dari rekam medis dan ruang kateterisasi. Durasi data yang diambil adalah Agustus 2015 - April 2016. Hasil penelitian dianalisis dengan prosedur Receiver Operating Characteristic (ROC) dari rasio V/LFG. Akan dianalisis nilai Area Under Curve dan mencari titik potong yang direkomendasikan sebagai nilai prediktor optimal dengan sensitivitas dan spesifisitas yang terukur.Hasil. Dari 223 data yang terkumpul lengkap dan sesuai dengan kriteria inklusi dan eksklusi didapatkan jumlah pasien yang mengalami CIN adalah sebesar 11 pasien (4,9%). Didapatkan perbedaan bermakna pada kedua jenis kelompok yaitu pada variabel jenis tindakan (P = 0,04), volume kontras (P = 0,02), dan rasio V/LFG (P = 0,032). Dari kurva ROC didapatkan bahwa rasio V/LFG mempunyai nilai AUC 0,69 (IK 95% 0,53 - 0,86). Dari kurva ROC ditentukan nilai potong yang bermakna dari rasio V/LFG ≥ 1,0 (Sensitifitas 55%, Spesifisitas 78%, Akurasi 77%, Nilai Prediksi Positif 12%, Nilai Prediksi Negatif 97%, P = 0,022). Dengan menggunakan rasio V/LFG ≥ 1 didapatkan insidensi CIN adalah 12% dibandingkan 3% pada pasien dengan V/LFG < 1 (OR 4,33; IK 95% 1,27 - 14, 83); P = 0,022).Kesimpulan. Rasio V/LFG ≥ 1,0 dapat memprediksi kejadian CIN pada pasien risiko rendah yang menjalani tindakan angiografi atau intervensi koroner perkutan elektif

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ABSTRACT

Background: Contrast media could give toxic effect to renal tubulus, creatining a condition named contrast induced nephropathy (CIN) and is associated with increased morbidity and mortality, and has the same effect in patient with chronic kidney disease or in low risk patients (estimated Glomerolus Filtration Rate (eGFR) ≥ 60, Mehran Score before procedure ≤ 5). From several studies concerning ratio of contrast volume to creatinine clearance (V/CrCl) to predict CIN, there were not any study yet focusing in low risk patients.

Methods: This is a cross-sectional study conducted in Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita (NCCHK). The data were retrieved from medical records and catheterization room, since August 2015 -- April 2016. Receiver Operating Characteristic (ROC) is used to analyze the data, and by using Area Under Curve will gives the optimal cut-off for contrast volume to creatinine clearance ratio with measured sensitivity and specificity.

Results: From 223 patients the incidence of CIN is 11 patients (4,9%). There is a significant difference from both groups in types of procedure (P = 0,04), contrast volume (P = 0,02), and V/CrCl ratio (P = 0,032). From ROC curve we found that V/CrCl ratio have an AUC 0,69 (CI 95% 0,53 - 0,86). From ROC curve the significant cut-off ratio of V/CrCl is ≥ 1,0 (Sensitifity 55%, Specificity 78%, Accuracy 77%, Positive Predictive Value 12%, Negative Predictive Value 97%, P = 0,022). Using V/CrCl ratio ≥ 1,0 the incidence of CIN is 12%, compared to 3% in patients with V/LFG < 1,0 (odds ratio 4,33; CI 95% 1,27 - 14, 83); P = 0,022).

Conclusions: V/CrCl ratio ≥ 1,0 could predict CIN in low risk patients undergoing angiography or percutaneous coronary intervention."

"Sindrom koroner akut (SKA) merupakan masalah kesehatan nasional karena tingginya angka morbiditas dan mortalitas serta beban biaya yang dibutuhkan. Intervensi koroner perkutan (IKP) dan terapi antiplatelet seperti klopidogrel merupakan tata laksana yang direkomendasikan oleh organisasi kardiologi internasional. Meskipun demikian, pasien SKA masih dapat mengalami kejadian kardiovaskular mayor (KKM). Kemungkinan, resistensi klopidogrel berperan pada KKM sedangkan resistensi klopidogrel mungkin dipengaruhi oleh faktor genetik dan epigenetik. Penelitian ini bertujuan untuk mengetahui hubungan faktor genetik yaitu polimorfisme gen CYP2C19 dan P2Y12, serta epigenetik yaitu metilasi DNA gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dengan resistensi klopidogrel dan pengaruhnya terhadap KKM pada pasien SKA pasca IKP.Untuk menganalisis hubungan faktor genetik dan epigenetik dengan resistensi klopidogrel, penelitian dilakukan dengan desain potong lintang, sedangkan untuk analisis hubungan faktor genetik dan epigenetik dengan KKM dilakukan dengan desain kohort prospektif. Subjek penelitian meliputi 201 pasien SKA pasca IKP dan mendapat terapi klopidogrel di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2018 sampai dengan Juni 2020. Resistensi klopidogrel ditentukan dengan pemeriksaan light transmission aggregometry (LTA) apabila hasilnya lebih besar dari 59% dengan agonis ADP 20 mM. Deteksi polimorfisme gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dilakukan dengan metode qRT-PCR, sedangkan metilasi DNA gen CYP2C19 dan P2Y12 dikerjakan dengan metode konversi bisulfit. Pasien diobservasi selama satu tahun dan jika ada angina pektoris, infark miokard akut (IMA) rekuren, stroke, atau kematian, dicatat sebagai KKM.Dari 201 subjek, terdapat 45,8% carrier mutant polimorfisme *2 dan *3 gen CYP2C19, 36,8% carrier mutant polimorfisme rs3679479 gen P2Y12, 10% hipometilasi DNA gen P2Y12, 80,1% hipometilasi DNA gen CYP2C19, dan 66,2% ekspresi miRNA-26a up regulated. Proporsi resisten klopidogrel adalah 49,8% dan proporsi KKM adalah 14,9% (kematian 7,5%). Terdapat hubungan antara merokok (p = 0,001; OR 0,37 [IK 95%; 0,20–0,68]), hipometilasi DNA gen CYP2C19 (p = 0,037; OR 2,13 [IK 95%; 1,04–4,37]), dan ekspresi miRNA-26a up regulated (p = 0,020; OR 2,03 [IK 95%; 1,12–3,68]) dengan resistensi klopidogrel. Terdapat hubungan antara jenis kelamin perempuan (p = 0,040; HR 2,73 [IK 95%; 1,05–7,14]), usia ≥ 60 tahun (p = 0,035; HR 2,17 [IK 95%; 1,06–4,48]), eGFR rendah (p = 0,001; HR 3,29 [IK 95%; 1,59–6,84]), dan polimorfisme *2 dan *3 gen CYP2C19 (p = 0,047; HR 2,12 [IK 95%; 1,01–4,46]) dengan KKM dalam satu tahun.Hanya faktor epigenetik berupa metilasi DNA gen CYP2C19 dan ekspresi miRNA-26a yang berhubungan dengan resistensi klopidogrel. Walaupun resistensi klopidogrel tidak berhubungan dengan KKM, terdapat hubungan antara faktor genetik polimorfisme *2 dan *3 gen CYP2C19 dengan KKM.

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Acute coronary syndrome (ACS) is a national health problem due to high morbidity and mortality, and cost burden as well. Percutaneous coronary intervention (PCI) and antiplatelet therapy such as clopidogrel are recommended. However, ACS patients could still experience major adverse cardiovascular events (MACE). Clopidogrel resistance possibly plays a role in MACE whereas it may be affected by genetic and epigenetic factors. Therefore, the objective of this study was to determine the relationship between genetic factors which are CYP2C19 and P2Y12 polymorphisms, as well as epigenetic factors which are DNA methylation of CYP2C19 and P2Y12, and miRNA-26a expression and their effects on MACE in post-PCI patients.

To analyze the association between genetic and epigenetic factors and clopidogrel resistance, the study design was cross-sectional, while the study design of relationship between genetic and epigenetic factors and MACE was prospective cohort. The subjects were 201 post-PCI ACS patients who received clopidogrel therapy at Harapan Kita Hospital from September 2018 to June 2020. Clopidogrel resistance was determined by light transmission aggregometry (LTA) if the result was greater than 59% with agonist ADP 20 µM. The detection of CYP2C19 and P2Y12 gene polymorphisms and miRNA-26a expression were carried out by qRT-PCR method, while the DNA methylation of the CYP2C19 and P2Y12 genes were carried out by bisulfite conversion method. Patients were observed for one year and angina pectoris, recurrent acute myocardial infarction (AMI), stroke, or death, were recorded as MACE.

From 201 subjects, 45.8% were CYP2C19*2 and CYP2C19*3 polymorphism mutant carrier, 36.8% were rs3679479 P2Y12 polymorphism mutant carrier, 10% were hypomethylated of P2Y12, 80.1% were hypomethylated of CYP2C19, and 66.2% were up regulated in miRNA-26a expression. 49.8% of subjects were clopidogrel resistant and 14.9% of subjects experienced MACE (death was 7.5%). Smoking (p = 0.001; OR 0.37 [CI 95%; 0.20–0.68]), hypomethylated of CYP2C19 (p = 0.037; OR 2.13 [CI 95%; 1.04–4.37]), and up regulated miRNA-26a expression (p = 0.020; OR 2.03 [CI 95%; 1.12–3.68]) were associated with clopidogrel resistance. Female gender (p = 0.040; HR 2.73 [CI 95%; 1.05–7.14]), age over 60 years old (p = 0.035; HR 2.17 [CI 95%; 1.06–4.48]), low eGFR (p = 0.001; HR 3.29 [CI 95%; 1.59–6.84]), and CYP2C19*2 and CYP2C19*3 polymorphisms (p = 0.047; HR 2.12 [CI 95%; 1.01–4.46]) were associated with MACE in one year.

Only DNA methylation of CYP2C19 and miRNA-26a expression were associated with clopidogrel resistance. Although clopidogrel resistance was not associated with MACE, there was association between CYP2C19*2 and CYP2C19*3 polymorphisms and MACE."

"Intervensi koroner perkutan (IKP) terbukti mengurangi morbiditas dan mortalitas penyakit jantung koroner (PJK). Cedera pembuluh darah akibat IKP dapat menyebabkan timbulnya inflamasi dan stress oksidatif. Studi ini menunjukkan bahwa kurkumin memiliki efek menekan inflamasi dan antioksidan pada penderita PJK stabil pasca-IKP. Penelitian ini bertujuan untuk mengetahui efektivitas suplementasi kurkumin per oral dalam menurunkan kadar inflamasi dan stres oksidatif pasca-IKP pasien PJK stabil.Pasien dewasa PJK stabil dilakukan IKP, dirandomisasi secara acak tersamar ganda ke dalam kelompok kurkumin atau plasebo. Kurkumin (45 mg/hari) atau plasebo diberikan selama 7 hari sebelum IKP hingga 2 hari setelah IKP. Kadar marker inflamasi (hsCRP dan sCD40L) dan marker oksidatif (MDA dan GSH) dalam serum dinilai dalam 3 fase, 7 hari pra-IKP, 24 jam pasca-IKP, dan 48 jam pasca-IKP.Selama periode April–Juni 2015, terdapat 50 pasien yang direkrut (25 kurkumin dan 25 plasebo) di RSUP Cipto Mangunkusumo dan RS Jantung Jakarta. Konsentrasi hsCRP dan sCD40L pada kelompok kurkumin dalam 3 fase cendrung menurun (p < 0,05) dibanding kelompok plasebo, tetapi konsentrasi hsCRP dan sCD40L pada tiap fase tidak berbedaan bermakna, sedang kadar MDA dan GSH tidak berbeda bermakna setiap fase, namun menunjukkan kecenderungan penurunan kadar MDA (p = 0,6) dan GSH (p = 0,3).Pemberian kurkumin mempunyai kecenderungan menurunkan respons inflamasi pasca-IKP dan cenderung menghambat pembentukan stress oksidatif yaitu MDA serum melalui mekanisme peningkatan penggunaan antioksidan internal yaitu GSH serum.

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Background: Percutaneous coronary intervention (PCI) has been proven to improve morbidities and mortalities in stable coronary heart disease (CHD). However, ischemia-reperfusion injury resulted from PCI might induce inflammation and oxidative stress. Several studies suggested that curcumin exerts anti-inflammatory and antioxidant properties that may be beneficial in post-PCI stable CHD patients.

Objectives: To determine the efficacy of orally administered curcumin in reducing inflammatory response and oxidative stress in post-PCI of stable CHD patients.

Methods: A double-blind randomized controlled trial consisting of 50 adult patients of both sexes with stable CHD who underwent PCI were treated with curcumin or placebo. Either curcumin (45 mg/day) or placebo was given 7 days prior to PCI until 2 days after PCI. Inflammatory markers (hsCRP and sCD40L) and oxidative stress assessment (MDA and GSH) were measured in 3 phases (7 days pre-PCI, 24 hours post-PCI, and 48 hours post-PCI).

Results: During April–June 2015, 50 patients were recruited (25 curcumin and 25 placebo) from Cipto Mangunkusumo General Hospital and Jakarta Heart Center. The serum concentrations of hsCRP and sCD40L in curcumin group (p < 0.05) in all observation phases were significantly lower compared with placebo group; however, there were no significant differences between groups. No significant difference was observed among phases in MDA and GSH, but there was a trend of decreasing MDA and GSH levels (p = 0.6 and p = 0.3, respectively) in curcumin group.

Conclusion: Curcumin tends to reduce inflammatory response following PCI by decreasing oxidative stress (MDA) through the increase of internal antioxidant utilization (GSH)."

"In-stent restenosis adalah komplikasi yang dapat terjadi setelah pemasangan stent. Penelitian ini bertujuan untuk mengidentifikasi faktor ? faktor yang berhubungan dengan tindakan PCI berulang. Desain penelitian menggunakan desain non eksperimental jenis cross sectional. Responden sebanyak 70 orang, diperoleh melalui teknik consecutive sampling. Analisis data dilakukan secara univariat, bivariat (chi square) serta multivariat (regresi logistik berganda). Hasil penelitian menunjukkan bahwa riwayat merokok memiliki hubungan yang signifikan dan merupakan faktor dominan dengan tindakan PCI berulang. Implikasi dalam keperawatan adalah peningkatan peran perawat sebagai pendidik dalam memberikan pendidikan kesehatan tentang pengendalian faktor risiko yakni kebiasaan merokok pada pasien yang terpasang stent dalam mencegah in-stent restenosis.

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In-stent restenosis is a complication that can occur after stenting. This study aimed to identify factors related to re-PCI. A non-experimental design with cross sectional approach was used in this research, while 70 respondents were obtained through a consecutive sampling technique. Data analyzed was performed using univariate, bivariate (chi square) and multivariate (multiple logistic regression) tests.

The results showed that a history of smoking has a significant relationship with the re-PCI and history of smoking is the dominant factor associated with re-PCI. Implications of the research to nursing is to improve of the role of nurses as educators in providing health education to control risk factors, especially smoking habits in patients who mounted stents in order to prevent in-stent restenosis."

"ABSTRAKN-acetyl-L-cysteine-sodium hydroxide NALC-NaOH dan Modified Petroff merupakan dua metode dekontaminasi yang cukup sering digunakan untuk kultur TB. Pada penelitian berdesain cross sectional ini, dilakukan perbandingan proporsi kultur terkontaminasi dan hasil kultur positif antara kelompok sampel yang diproses dengan NALC-NaOH dan Modified Petroff. Analisis bivariat menunjukan bahwa proporsi kultur terkontaminasi pada sampel yang diproses dengan teknik NALC-NaOH 38,2 secara signifikan p=0,034 lebih tinggi dibanding dengan teknik Modified Petroff 18,2 . Akan tetapi, tidak terdapat perbedaan yang signifikan p=1,000 antara proporsi hasil kultur positif pada kelompok sampel yang diproses dengan teknik NALC-NaOH 73,5 dan Modified Petroff 73,3 . Hasil yang diperoleh pada penelitian ini berbeda dengan hasil penelitian yang sebelumnya telah membandingkan antara teknik NALC-NaOH dan Modified Petroff.

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ABSTRACTN acetyl L cysteine sodium hydroxide NALC NaOH and Modified Petroff are two decontamination methods that are widely used for TB culture. This cross sectional study compares the proportion of contaminated culture and positive culture result between samples treated with NALC NaOH and Modified Petroff. Bivariate analysis of the data showed that the proportion of contaminated culture was significantly p 0,034 higher in samples treated with NALC NaOH 38,2 than in those treated with Modified Petroff 18,2 . However, significant difference in the proportion of positive culture result between samples treated with NALC NaOH 73,5 and Modified Petroff 73,3 was not shown p 1,000 . The result of this study differs from that of previous study that compared NALC NaOH and Modified Petroff."

"Latar belakang. Kondisi iskemia pada penyakit jantung koroner (PJK) berkorelasi dengan disfungsi sistem saraf otonom. Revaskularisasi melalui percutaneous coronary intervention (PCI) dapat mengembalikan keseimbangan fungsi saraf otonom dan memperbaiki prognosis. Di sisi lain, perasaan cemas yang muncul menjelang prosedur PCI, dapat memicu hiperaktivitas simpatis. Tujuan penelitian ini adalah untuk mengetahui pengaruh ansietas terhadap perbaikan heart rate variability (HRV), sebuah teknik non-invasif untuk mengevaluasi aktivitas sistem saraf otonom; setelah tindakan PCI. Metode. Studi dengan desain potong lintang, korelasi pretest-posttest; melibatkan 44 subjek dengan PJK stabil yang menjalani PCI elektif di Pelayanan Jantung Terpadu, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Pengukuran HRV dilakukan sebelum PCI, kemudian diulang pasca tindakan PCI. Ansietas dinilai menggunakan kuesioner hospital anxiety depression score (HADS). Pengolahan data serta analisis statistik dilakukan dengan bantuan software SPSS 20.0. Hasil. Sebanyak 54,5% subjek mengalami ansietas saat akan menjalani PCI. Pada kelompok tanpa ansietas, ditemukan perbaikan signifikan pada parameter HRV sebelum-setelah PCI; yaitu SDNN [standard deviation of normal to normal intervals] (Median = 26,19 vs. Median = 39,60 ; Z = -3,621 ; p < 0,001) dan parameter RMSSD [root mean square of the successive differences] (Median = 21,90 vs. Median = 30,99; Z = -2,501; p = 0,012). Sementara itu, tidak didapatkan perbaikan bermakna parameter HRV sebelum-setelah PCI, pada kelompok ansietas. Terdapat perbedaan bermakna pada kenaikan nilai SDNN antara kelompok tanpa ansietas dibandingkan dengan kelompok ansietas ansietas (Median = 9,11 vs. Median = 2,83 ; U = 154,00 ; p = 0,043). Simpulan. Ansietas yang terjadi sebelum PCI elektif dapat menghambat perbaikan HRV pasca tindakan sehingga mempengaruhi prognosis penyakit. Diperlukan penelitian lanjutan mengenai peranan terapi ansietas menjelang PCI dihubungkan dengan luaran klinis serta prognosis pasca PCI.

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Background. Chronic ischemic condition in coronary artery disease (CAD) was associated with autonomic dysfunction. Percutaneous coronary intervention (PCI) could restore perfusion so that improving autonomic balance and disease prognosis. On the other hand, pre-PCI anxiety was known to produce sympathetic hyperactivity. The aim of this study was to determine whether pre-PCI anxiety may influence heart rate variability (HRV) improvement, a noninvasive technique for the evaluation of the autonomic nervous system activity; after successful PCI.

Methods. A cross sectional studies, pretest-posttest correlation; enclose 44 patients with stable CAD undergoing PCI in Integrated Heart Service, Cipto Mangunkusumo National Hospital. HRV measurement was done before and after PCI. Anxiety symptoms was collected using hospital anxiety depression score (HADS) questionnaires. Data input and statistical analysis was carried out using SPSS 20.0 for Windows.

Results. As many as 54.5% stable CAD patients undergoing elective PCI experienced anxiety symptoms. In the anxiety group, there were significant post-PCI improvement of SDNN [standard deviation of normal to normal intervals] (Median = 26.19 vs. Median = 39.60; Z = -3.621; p < 0.001) and RMSSD [root mean square of the successive differences] (Median = 21.90 vs. Median = 30.99; Z = -2.501; p = 0.012). Post-procedure HRV improvement was not significant in patients with anxiety symptoms. There was significant difference of the SDNN improvement between non-anxiety and anxiety patients (Median = 9.11 vs. Median = 2.83; U = 154.00; p = 0.043).

Conclusions. Pre-PCI anxiety may affect HRV improvement after revascularization thus influence disease prognosis. Further studies are needed to determine the impact of pre-PCI anxiety treatment on cardiac outcomes."

"Pendahuluan: Cidera ginjal akut akibat kontras radiografi yang sering disebut sebagai Contrast-induced nephropathy (CIN) telah menjadi sumber morbiditas dan mortalitas di rumah sakit dengan terus meningkatnya penggunaan media kontras iodinasi dalam pencitraan diagnostik dan prosedur intervensi seperti angiografi pada pasien berisiko tinggi (mencapai 50%) pada 10 sampai 15 tahun terakhir. Terjadi dapat dalam 2 sampai 5 hari setelah tindakan. Metodologi: Sebanyak 101 pasien elektif untuk tindakan kateterisasi jantung diambil dalam studi eksperimental ini dengan metode consecutive sampling, mulai bulan Agustus hingga November 2013. Sampel penelitian dibagi menjadi dua kelompok metode hidrasi yaitu metode hidrasi LVEDP dan metode hidrasi standar. Diagnosis cidera ginjal akut akibat kontras ditegakkan berdasarkan kenaikan kadar serum kreatinin sebesar 0.5 mg/dL atau 25% dalam 3 hari setelah tindakan. Hasil: Dalam studi kami, terdapat 5 orang mengalami cidera ginjal akut akibat kontras, 3 orang (5.7%) dari metode hidrasi LVEDP dan 2 orang (4.2%) dari metode hidrasi standar. Secara statistik angka kejadian cidera ginjal akut pada dua kelompok tidak berbeda bermakna dengan nilai p=0.731. Setelah melalui uji regresi multivariat terhadap variabel-variabel yang dapat mempengaruhi didapatkan nilai odds rasio metode hidrasi LVEDP sebesar 3.6 (95% CI 0.4 - 31.3) terhadap metode hidrasi standar. Kesimpulan: Angka kejadian cidera ginjal akut akibat kontras radiografi antara metode LVEDP dan metode standar tidak berbeda bermakna secara statistik tetapi tampaknya metode LVEDP memiliki kecenderungan meningkatkan risiko untuk terjadi cidera ginjal akut sebesar 3.6 kali dibandingkan dengan metode standar yang digunakan di Rumah Sakit Pusat Jantung Nasional Harapan Kita.

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Background: Contrast Induced Nephropathy (CIN) remains a major problem because of the use of iodinated contrast media in heart catheterization is increasing. Incidence of CIN among high-risk patients is up to 50%. Intravenous hydration with normal saline before and after cardiac catheterization is the most effective methods to prevent this problem, but the hydration rate, duration and total hydration amount is still a question. By using Left Ventricular End Diastolic Pressure (LVEDP) data, we could adjust the hydration according to the needs of each patient.

Methods: A total of 101 high-risk patients (estimated Glomerular Filtration Rate by Cockroft-Gault <60mL/min/1.73m2) who undergoes elective heart catheterization were included in this study from August to November 2013 at the Cardiovascular Hospital Harapan Kita Jakarta. Samples were divided into two groups of hydration methods (standard and LVEDP based) by consecutive sampling methods. CIN is diagnosed by absolute rise of > 0.5% mg/dL or 25% increase of serum creatinine from baseline within 3 days after procedures.

Results: There were total of 5 patients who experienced CIN, 3 (5.7%) patients from LVEDP hydration method and 2 (4.2%) patients from standard hydration method. Statistically, the incidence of CIN between two groups was not significant with p=0.731. After a multivariate regression analysis, the odd ratio of LVEDP hydration method is 3.6 (95% confident interval of 0.4 - 31.3).

Conclusion: There is no statistically significant difference incidence of CIN between LVEDP hydration method and standard hydration methods, but LVEDP hydration method seems tend to increase the risk of CIN."

"Latar Belakang: Angka harapan hidup yang meningkat menyebabkan peningkatan populasi usia lanjut termasuk populasi usia lanjut dengan penyakit jantung koroner. Frailty sering ditemukan pada pasien usia lanjut dengan penyakit kardiovaskular dan keberadaan frailty sangat mempengaruhi prognosis penyakit jantung koroner pada pasien usia lanjut termasuk luaran terhadap intervensi revaskularisasi. Percutaneous Coronary Intervention (PCI) adalah salah satu metode revaskularisasi dan belum banyak penelitian yang dilakukan terkait pengaruh frailty terhadap luaran pasien usia lanjut yang menjalani PCI elektif. Tujuan: Penelitian ini dilakukan untuk mendapatkan proporsi frailty, insidensi Major Adverse Cardiovascular Events (MACE) 30 hari dan mengkaji peran frailty terhadap prognosis pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif. Metode: Secara prospektif dilakukan penilaian terhadap kondisi frailty pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif di RS Cipto Mangunkusumo dengan menggunakan kriteria Frailty Phenotipe. Pasien kemudian di follow-up selama 30 hari setelah tindakan PCI elektif untuk melihat apakah MACE terjadi atau tidak. Hasil: Terdapat 100 pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif dari bulan September 2014 - Juni 2015. Usia rata-rata pasien adalah 66.95 tahun (SD = 4.875) dengan pasien terbanyak adalah laki-laki (69%). Sebanyak 61% pasien termasuk ke dalam kelompok frail. MACE terjadi pada 8.19% pasien pada kelompok frail dan 5.12% pada kelompok non-frail. Hubungan frailty terhadap MACE dapat dilihat dari hasil crude Hazard Ratio (HR) 1.6 (IK 95% 0.31-8.24). Pada penelitian ini, kesintasan 30 hari 95% pada kelompok frail, sementara pada kelompok non-frail kesintasan 30 hari adalah sebesar 98%. Kesimpulan: Terdapat peningkatan risiko 1.6 kali untuk terjadinya MACE 30 hari pada subyek usia lanjut frail yang menjalani PCI elektif namun belum bermakna secara statistik.

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Background: The increase in life expectancy caused the increase in elderly population including the population of elderly with Coronary Artery Disease. Frailty is commonly found in elderly patients with cardiovascular disease and frailty had a major influence in determining the prognosis of cardiovascular disease in elderly including the outcome of revascularization intervention. PCI (Percutaneous Coronary Intervention) is one method of revascularization. However, frailty research on the effect on the outcome of elderly patients with coronary artery disease undergoing PCI is still limited.

Aim: To get the proportion of frailty and 30 days Major Adverse Cardiovascular Events (MACE) incidence, and to review impact of frailty in elderly patients with coronary heart disease who underwent elective PCI.

Method: The frailty condition of the elderly patients with coronary artery disease that underwent elective PCI in Cipto Mangunkusumo Hospital was assessed with the Frailty Phenotype criteria. After the patients underwent the elective PCI, they were followed for 30 days to see whether MACE occurred or not.

Result: There are 100 elderly patients with coronary artery disease that underwent elective PCI from September, 2014 until June, 2015. The mean age of patients is 66.95 ± 4.875 years and 69% of the patients were males. Frail was present in 61% of the patients. MACE were occurred in 8.19% of frail patients and 5.12% were occurred in non-frail patients. The correlation between frailty and MACE could be seen in the result of crude HR 1.6 (CI 95% 0.31-8.24). In this research, the 30 days survival rate is 95% in frail patients and 98% in non-frail patients.

Conclusion: There is a 1.6 fold increased risk of 30 days MACE in elderly frail patients that underwent elective PCI but it is not statistically significant."