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"Latar belakang: Sindrom koroner akut SKA merupakan penyebab utama peningkatan morbiditas dan mortalitas di seluruh dunia. Mortalitas SKA dari berbagai studi di luar negeri diketahui berhubungan dengan kadar kalium serum saat admisi. Penelitian mengenai hubungan kadar kalium serum dengan mortalitas pada SKA masih perlu dilakukan karena adanya kemajuan dalam terapi kardiovaskular yang cukup pesat terutama pada era PCI saat ini dan adanya hasil yang bertolakbelakang antara studi terbaru dengan panduan yang ada. Tujuan: Menilai hubungan antara kadar kalium serum saat admisi dengan mortalitas selama perawatan pasien SKA in-hospital mortality. Metode: Data kadar kalium dan kematian diperoleh dari rekam medis dengan desain studi kohort retrospektif terhadap 673 pasien SKA yang dirawat dengan sindrom koroner akut di RSUPN Cipto Mangunkusumo. Keluaran utama yang diamati berupa mortalitas selama perawatan. Analisis bivariat dengan Pearson Chi-square dan multivariat menggunakan regresi logistik dilakukan untuk menentukan hubungan antara kadar kalium serum abnormal dengan kematian pada sindrom koroner akut. Hasil dan Pembahasan: Subjek yang datang dengan kadar kalium serum yang abnormal K < 3,50 mEq/L atau > 5,0 mEq/L saat admisi sebesar 24,22 163 pasien , sedangkan grup dengan kalium normal sebesar 510 subjek 75,78. Dari analisis regresi logistik, setelah adjustment terhadap faktor perancu eGFR, didapatkan hubungan yang bermakna antara kadar kalium serum abnormal saat admisi dengan mortalitas selama perawatan dengan nilai p = 0,04 adjusted RR 2,184; 95 CI: 1,037-4,601. Terjadi peningkatan risiko mortalitas pada subjek dengan kadar serum kalium 4,0-

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Background: Acute coronary syndrome ACS is the leading cause of increased morbidity and mortality across the globe. This mortality was known to be associated to the serum potassium level on admission. More studies are still needed due to rapid advancement in cardiovascular medicine especially in the era of interventional cardiology and also the conflicting results that exist between recent studies and established guidelines.

Aims: To determine association between serum potassium levels on admission of subjects with acute coronary syndrome and in-hospital mortality.

Methods: Included in the study were 673 acute coronary syndrome patients hospitalised in Indonesian National Cipto Mangunkusumo Hospital. The outcome of the study was all-cause in-hospital mortality. Logistic regression models adjusted for risk factors, hospital treatment, and co-morbidities were constructed.

Results: Total of 163 patients 24,22 with abnormal serum potassium K < 3,50 mEq/L or > 5,0 mEq/L and 510 subjects with normal serum potassium 75.78. Logistic regression analysis after adjustment of the confounder eGFR shows significant association between serum potassium level on admission and in-hospital mortality with p value of 0,04 adjusted RR 2.184; 95 CI: 1.037-4.601. The risk of dying for patients with serum potassium of 4.0-."

"[ABSTRAKLatar Belakang: Major adverse cardiac events (MACE) merupakan komplikasi serius pada pasien pasca sindrom koroner akut (SKA) sehingga perlu suatu metode yang andal dalam memprediksi kejadiannya. Heart rate variability (HRV) yang menggambarkan ketidakseimbangan sistem otonom pasca SKA dan dapat dilakukan dengan cara yang lebih cepat, mudah, dan praktis berpotensi dapat digunakan sebagai alat stratifikasi risiko MACE.Tujuan: Mengetahui kemampuan HRV awal perawatan yang diukur melalui metode pulse photoplethysmograph (PPG) dalam memprediksi MACE pada pasien pasca SKA yang dirawat di intensive cardiac care unit (ICCU).Metode: Studi ini adalah studi kohort prospektif dengan subjek pasien SKA yang menjalani perawatan di ICCU. Pemeriksaan HRV dilakukan dengan metode PPG dalam 48 jam pasca diagnosis SKA dan adanya MACE dideteksi selama perawatan di ICCU. Komplikasi yang digolongkan sebagai MACE adalah kematian, aritmia fatal, gagal jantung, syok kardiogenik, re-infark, dan komplikasi mekanik. Kemampuan HRV dalam memprediksi MACE dinyatakan melalui AUC (+IK95%) dan untuk parameter yang memiliki kemampuan prediksi baik akan dihitung nilai prediksi positif (PPV) dan nilai prediksi negatif (NPV) beserta IK95% parameter tersebut.Hasil: Sebanyak 75 subjek SKA menjalani pengukuran HRV < 48 jam pasca diagnosis dan sebanyak 18,7% di antaranya mengalami MACE. Parameter LF dengan AUC 0,697 (0,543-0,850) dan rasio LF/HF dengan AUC 0,851 (0,741-0,962) memiliki kemampuan diskriminasi MACE yang paling baik. Parameter LF pada titik potong 89,673 memiliki PPV dan NPV sebesar 13% dan 71%, sedangkan rasio LF/HF pada titik potong 1,718 sebesar 6% dan 50%.Kesimpulan: Variabel LF dan rasio LF/HF merupakan parameter HRV yang dinilai memiliki kemampuan diskriminasi cukup baik terhadap MACE. Kedua variabel tersebut memiliki nilai prediksi negatif sehingga dapat digunakan untuk menyingkirkan kemungkinan terjadinya MACE pada mereka dengan nilai LF > 89,673 dan rasio LF/HR > 1,718.

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ABSTRACTIntroduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.;Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718., Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.]"

"Latar belakang. Gagal jantung akut telah menjadi masalah kesehatan diseluruh dunia dengan penyakit jantung koroner sebagai penyebab terbanyak.Tujuan. Mengetahui hubungan antara penyakit jantung koroner dengan mortalitas pasien gagal jantung akut selama perawatan.Metode. Penelitian dilakukan dengan desain potong lintang serta menggunakan 685 data sekunder dari studi Acute Decompensated Heart Failure Registry (ADHERE) di lima rumah sakit di Indonesia pada bulan Desember 2005 ? 2006.Hasil. Penelitian ini melibatkan 957 pasien gagal jantung akut. Proporsi pasien gagal jantung akut yang mengalami penyakit jantung koroner di lima rumah sakit di Indonesia pada bulan Desember 2005 ? 2006 mencapai 74,8 %. Angka mortalitas pasien gagal jantung akut selama perawatan secara umum adalah 4,1 %. Angka mortalitas pasien yang mengalami PJK lebih tinggi dibandingkan pasien tanpa PJK (P = 0,493, OR = 1,3, CI 95% 0,59 ? 2,90). Angka mortalitas pasien gagal jantung akut yang disertai penyakit jantung koroner selama perawatan adalah 4,3 %, Sedangkan pada pasien tanpa penyakit jantung koroner adalah 3,3 %.Kesimpulan. Tidak terdapat hubungan bermakna antara riwayat penyakit jantung koroner dengan angka mortalitas gagal jantung akut selama perawatan di lima rumah sakit di Indonesia pada bulan Desember 2005 - 2006.

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Background. Acute heart failure has become health problem on the world and coronary heart disease is known as common etiology.

Objective. To determine relationship between history of coronary heart disease and mortality of acute heart failure

Method. This study was conducted by using cross sectional method. Using 685 secondary data from study Acute Decompensated Heart Failure Registry (ADHERE) in five hospital in Indonesia on December 2005 -2006.

Result. From 957 patient acute heart failure, about 76,2 % patient have coronary heart disease. Overall in-hospital mortality among patient with acute heart failure is 4,1 %. In-hospital mortality in patient with coronary heart disease is 4,3 % and 3,3 % in patient without coronary heart disease (P = 0,493, OR = 1,3, CI 95% 0,59 - 2,90).

Conclusion. There is no significant relationship between coronary heart disease and mortality of acute heart Failure in five hospitals in Indonesia on December 2005-2006."

"Latar Belakang Sindrom koroner akut (SKA) merupakan suatu penyakit yang disebabkan oleh penyumbatan pada arteri koroner jantung. Gejala utamanya adalah nyeri dada, yang disebut juga sebagai angina pektoris. TIMI risk score adalah suatu sarana penilaian risiko yang mengevaluasi berbagai faktor untuk menentukan prognosis pasien SKA. Namun, TIMI risk score tidak memperhitungkan tingkat transaminase aspartat serum dan transaminase alanina serum saat admisi pasien. Penelitian ini bertujuan untuk melihat apabila terdapat hubungan antara enzim tersebut dengan hasil TIMI risk score.Metode Penelitian ini merupakan suatu studi cross-sectional analitik yang dilaksanakan melalui pengumpulan data rekam medik Rumah Sakit Cipto Mangunkusumo, yang meliputi TIMI risk score, tingkat transaminase aspartat serum saat admisi pasien, dan tingkat transaminase alanina serum saat admisi pasien. Terdapat 111 sampel dan data yang telah diperoleh dianalisis menggunakan program SPSS.Hasil Tingkat transaminase aspartate serum pada saat admisi tidak berhubungan dengan hasil TIMI risk score pasien (p=,183). Tidak ditemukan hubungan statistik yang bermakna antara tingkat transaminase alanina serum pada saat admisi dengan hasil TIMI risk score pasien (p=,835).

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Background Acute coronary syndrome (ACS) is a disease caused by blockage in the coronary arteries. Its characteristic symptom is chest pain, also called as angina pectoris. TIMI risk score is a risk assessment method that evaluate various factors to determine the prognosis of ACS patients. However, it does not take into account admission serum AST and ALT levels of the patient. This research aims to see whether the said liver enzymes are associated with TIMI risk score results.

Method The research is an analytical cross-sectional research that is performed through data collection, which includes TIMI risk scores, admission serum AST levels, and admission serum ALT levels, from the medical records of Rumah Sakit Cipto Mangunkusumo. There are 111 samples collected and the data that has been gathered is analysed using the SPSS program.

Results Admission serum AST levels are not associated with patients’ TIMI risk score results (p=.183). There is also no statistical significance between the patient’s admission serum ALT and his/her TIMI risk score result (p=.835).

Conclusion Data analysis show that there are no significant association between patients’ admission serum AST and ALT with their TIMI risk score. Thus, the use of admission serum AST and ALT are not able to assess prognosis of ACS patients."

"Rasio Netrofil-Limfosit (RNL) adalah pemeriksaan laboratorium murah dan mudah didapatkan dimanapun, dan saat ini berkembang menjadi penanda luaran pada berbagai kondisi, termasuk pada Sindrom Koroner Akut (SKA). RNL menggabungkan dua jalur inflamasi berbeda (netrofil dan limfosit) untuk memprediksi luarannya, dan beberapa studi telah menunjukkan manfaatnya dalam memprediksi Major Adverse Cardiac Events (MACE). Penelitian ini bertujuan untuk membuktikan manfaat RNL dalam stratifikasi risiko SKA pada populasi Indonesia, dan menentukan nilai titik potong RNL untuk peningkatan risiko MACE. Metode: 380 rekam medis pasien SKA dari Januari 2012-Agustus 2015 diikutkan dalam studi ini. Karakteristik, faktor risiko kardiovaskuler, dan hasil pemeriksaan laboratorium subjek dikumpulkan dan diikuti secara retrospektif untuk menilai kemunculan MACE (aritmia, infark ulang, in-stent restenosis, gagal jantung akut, syok kardiogenik, kematian) selama perawatan. Nilai RNL didapatkan dari pembagian hitung netrofil dan limfosit absolut. Analisis statistik untuk menentukan nilai titik potong RNL dan penyesuaian untuk faktor perancu dilakukan untuk memvalidasi hasil. Hasil: Subjek mayoritas merupakan laki-laki, dengan rerata usia 57,92 tahun. Hipertensi dan merokok merupakan faktor risiko yang paling sering ditemukan. Rerata RNL subjek adalah 4,72, dan MACE ditemukan pada 73 kasus (19,2%). Setelah analisis ROC, didapatkan nilai titik potong sebesar 3.55 (sensitivitas 72,6%, spesitifitas 60,6%, AUC 0.702). Ditemukan bahwa terdapat peningkatan insidens MACE pada kelompok RNL>3.55 (30.47% vs 9.71% pada ≤3.55, p<0.001). Setelah penyesuaian untuk faktor perancu, RNL>3.55 tetap signifikan dalam memprediksi MACE (p=0.02, adujsted OR 2,626 (IK95% 1,401-4,922)). Kesimpulan: RNL>3.55 adalah prediktor independen untuk kejadian MACE.

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Background: Neutrophil-Lymphocyte Ratio (NLR) is a low-cost, readily available laboratory examination in various places, and is currently emerging as a prognostic marker for various conditions, including Acute Coronary Syndrome (ACS). NLR, which combines two different inflammatory pathways (neutrophil and lymphocyte), have been shown by several studies to be useful in predicting Major Adverse Cardiac Events (MACE). This study aims to prove NLR’s use in ACS risk stratification in Indonesians and determine a cutoff level for MACE risk increase.

Methods: 380 ACS patients’ medical records from January 2012 to August 2015 were included in this study. Subjects’ characteristics, cardiovascular risk factors and laboratory findings were collected, and retrospectively followed to evaluate for MACE (arrhythmia, reinfarction, in-stent restenosis, acute heart failure, cardiogenic shock, death) during hospitalization. NLR value was calculated from neutrophil and lymphocyte counts division. Statistical analysis to determine NLR cutoff point for MACE risks, and adjustment for confounding factors were done for results validation.

Results: Subjects were predominantly male, with average age of 57.92 years old. Hypertension and smoking were the most frequent risk factors found. Average NLR was 4.72, and MACE was found in 73 cases (19.2%). After ROC analysis, a cutoff of 3.55 was determined to be satisfactory (sensitivity 72.6%, spesitivity 60.6%, AUC 0.702). It was found that there is a significant increase in MACE incidence in NLR>3.55 (30.47% vs 9.71% in ≤3.55, p<0.001). After adjusting for confounding factors, NLR>3.55 was still significant in predicting MACE (p=0.02, adujsted OR 2,626 (CI95% 1,401-4,922)).

Conclusion: NLR>3.55 is an independent predictor of in-hospital MACE."

"ABSTRAKSindrom Koroner Akut SKA merupakan kondisi kegawatdaruratan akibat ketidakseimbangan antara kebutuhan oksigen miokardium dengan suplai darah yang dapat berakibat pada kematian. Penanganan SKA dengan intervensi koroner perkutan dapat meningkatkan kualitas hidup. Pedoman American Heart Association AHA merekomendasikan standar waktu ? 120 menit dari awal mula munculnya gejala hingga pasien tiba di rumah sakit yaitu. Namun masih ditemukan terjadinya keterlambatan prehospital. Penelitian ini bertujuan untuk mengidentifikasi hubungan representasi gejala dengan keterlambatan prehospital pada pasien sindrom SKA. Desain penelitian menggunakan cross sectional dengan metode purposive sampling yang melibatkan sampel sebanyak 63 responden. Responden didominasi oleh lansia yang berusia 51-60 tahun, laki-laki, tingkat Pendidikan SMA. Hasil penelitian menunjukan ada hubungan antara representasi gejala yang meliputi tingkat nyeri p 0.001, kualitas nyeri p 0.01, dan lokasi nyeri p 0.032 dengan keterlambatan prehospital terkecuali gejala penyerta p 0.054. Perawat dianjurkan meningkatkan kompetensi dalam pengkajian gejala SKA dan pemberian edukasi. Sehingga dapat menurunkan angka keterlambatan prehospital.

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ABSTRACTAcute Coronary Syndrome ACS is an emergency condition due to an imbalance between the need for oxygen and the blood supply that can result in death. ACS with percutaneous coronary intervention may improve the quality of life. The American Heart Association ACCF AHA guidelines recommended is 120 minutes from onset symptoms until hospital arrived. for recording time standards when facing symptoms arrive at the hospital However, there is still a pre hospital delay. This study aimed to identify correlation of symptoms representation with pre hospital delay in patients with ACS symptoms. This crossectional study design is cross sectional of purposive sampling method involved 63 respondents. Respondents mostly 51 60 years old, men, and high school education level. The results showed there was a correlation symptoms factor representation including pain level p 0.001, pain quality p 0,01, and pain location p 0,032 except commorbid symptom p 0,054. Nurses recommended to improve their ability to assess ACS symptoms and provide proper health education to decrease educational the prehospital delays."

"Latar Belakang: Studi epidemiologi menunjukkan bahwa DM merupakan salah satu faktor dalam proses terjadinya aterosklerosis dan mempengaruhi secara nyata kesaldtan dan kematian akibat PIK. Dibandingkan dengan penderita bukan DM, penderita DM 2-4 kali lebih banyak menderita P3K dan 2-4 kali lebih banyak mengalami kematian jangka pendek setelah menderita serangan infark miokard akut Dewabrata mendapati 23,2% penderita infark miokard akut yang di rawat di RSCM selama periode 1994-1999. Data di Indonesia tersebut belum banyak menggambarkan bagaimana karakteristik penderita DM tersebut saat terbukti menderita infark miokard akut. Dengan demildan, gambaran penderita DM yang mengalami sindrom koroner akut merupakan ha! yang renting untuk diketahui, baik karakteristik klinis maupun komplikasi yang muncul akibat S1CA tersebut.Tujuan. Penelitian ini ingin mengetahui prevalensi SKA pada penderita DM tipe-2. Penelitian ini juga ingin mengetahui karakteristik klinis dan komplikasi SKA pada penderita DM tipe-2 serta perbandingannya dengan penderita bukan DM. Metodologi. Studi potong lintang retrospektif untuk mengetahui prevalensi dan karakteristik klinis serta studi kohort retrospektif untuk mengetahui perbandingan komplikasi SKA pads penderita DM tipe-2 dan penderita bukan DM, terhadap penderita yang dirawat di ICCU RSCM periode 1 Januari 2001 s.d. 31 Desember 2005.Hasil. Didapatkan data: Prevalensi SKA penderita DM tipe-2: 34,2%. Awitan nyeri penderita DM lebih lama, 70,7% vs 53,4%, p=0,001; 1K 95%; DR=2,259 (1,372-3,719). Nyeri dada tidak khas, didapati penderita DM lebih banyak, 17,3% vs 9,8% p~ 0,041; 1K 95%; OR=1,713 (1,019-2,881)_ Komplikasi: Gagal jantung: penderita DM tipe-2 Iebih banyak: 39,35% vs 16,8%, p=0,001; 11(95%; RR-3,213 (1,992-5,182). Untuk komplikasi syok kardiogenik, didapati penderita DM tipe-2 Iebih banyak, 16,2% vs 8,9%, p= 0,031; IK 95%; RR==1,983 (1,057-3,721). Sedangkan komplikasi kematian didapati penderita DM tipe-2 lebih banyak, 17,3% vs 6,3%, dengan p= 0,001; 1K 95%; RR= 3,116 (1,556-6,239).Simpulan. Didapatkan perbedaan karakteristik klinis SKA antara penderita DM tipe-2 dengan penderita SKA bukan DM. Awitan nyeri lebih lama dan keluhan nyeri dada yang tidak khan, Iebih banyak didapati Dada penderita DM tipe-2. Didapatkan juga perbedaan dalam hat komplikasi SKA. Kejadian gagal jantung, syok kardiogenik dan kematian didapatkan lebih tinggi pada penderita DM tipe-2.

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Background. Epidemiologic studies revealed diabetes mellitus (DM) as one of the factors involved in atherosclerosis process. DM also influence morbidity and mortality-related to coronary artery disease (CAD). Compared to non diabetic patients, type -2 DM patients suffer CAD 2-4 times more often and had increased short term mortality rate due to acute myocardial infarction 2-4 times more likely. During 1994-1999, Dewabrata found 23.2% of all acute myocardial infarction patients was diabetic patients treated in ICCU Cipto Mangunkusumo hospital. Unfortunately these data did not describe the clinical characteristic and complication ACS in type -2 DM patients. Therefore it is important to know the clinical characteristics and ACS related complications in type-2 DM patients.

Objectives. To know the prevalence of type-2 DM among ACS patients, to learn clinical characteristics and ACS related complications in type-2 DM compared to non diabetic patients.

Methods. A cross sectional retrospective study was performed to know the prevalence of ACS in type -2 DM patients and their clinical characteristics_ A retrospective cohort study was performed to compare the differences in ACS related complications in type -2 DM and non diabetic patients who were hospitalized in ICCU Cipto Mangunkusumo hospital during 5 years period (January 1st, 200I December 31st, 2005).

Results. Prevalence of Type-2 DM among ACS patients : 34.2%. The onset of chest pain in type-2 DM patients was longer, 70.7% vs 53.4%, p=0.40l; CI 95%; OR=2.259 (1.372-3.719). Aypical chest pain were often in type-2 DM patients, 17.3% vs 9.8%; p= 0.041; CI 95%; OR 1.713 (L019 2.881). Heart failure as complications were more often found in type-2 DM patients, 39.35% vs 16.8%, p=0.001; CI 95%; RR=3.213 (1.992-5.182), cardiogenic shock were more often found in type-2 DM patients, 16.2% vs 8.9%, p= 0.031; CI 95%; RR 1.983 (1.057-3.721), and death were more often found in type-2 DM patients, 17.3% vs 6.3%, p= 0.001; CI 95%; RR= 3.116 (L556-6.239).

Conclusions. There are differences in clinical characteristics of ACS between type-2 DM patients and non diabetic patients; which are longer onset of chestpain and atypical chestpain more often in type-2 DM patients. There are also differences in complications related ACS between Type-2 DM patients and non diabetic patients; heart failure, cardiogenic shock, and death more often in Type-2 DM patients."

"Latar Belakang: Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya morbiditas dan mortalitas pada pasien sindrom koroner akut (SKA). Skor prediksi MACE merupakan model yang dapat memprediksi prognosis untuk terjadinya MACE berdasarkan faktor risiko yang dimiliki oleh pasien SKA. Tujuan: Untuk membuat skor prediksi sederhana, mudah dikalkulasi dan aplikatif, yang mampu mengidentifikasi pasien SKA dengan risiko terjadinya MACE. Metode: Dilakukan penelitian kohort retrospektif pada 1002 subyek pasien SKA yang dirawat di intensive coronary care unit RSCM dalam periode waktu Januari 2010 - Desember 2013. Dilakukan evaluasi terhadap faktor risiko jenis kelamin, usia, riwayat keluarga penyakit jantung koroner, diabetes, hemoglobin, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung, deviasi segmen ST dan kelas killip. Hasil: Major Adverse Cardiac Events didapatkan pada 112 subyek (9,21%), faktor prediktor jenis kelamin wanita, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung dan kelas killip pada analisis multivariat mempergunakan regresi logistik didapatkan berhubungan bermakna dengan MACE dengan RR (95% IK) masing-masing 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), dan 6.31 (3.19-12.50) serta didapatkan akurasi prediksi yang baik dengan nilai area under curve 0,95, 95% IK, 0,93-0,97. Kesimpulan: Pada pasien SKA didapatkan probabilitas MACE sebesar 3,6% bagi yang memiliki skor total 0-6 dan 83,5% bagi yang memiliki skor > 6 berdasarkan faktor-faktor prediktor jenis kelamin wanita (skor 1), leukositosis (skor 1), peningkatan kreatinin (skor 1), hiperurisemia (skor 2), peningkatan enzim jantung (skor 1), hipotensi (skor 2), takikardi (skor 1), henti jantung (skor 5) dan kelas killip III-IV (skor 3).

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Background: Major Adverse Cardiac Events (MACE) have been known as the cause of increasing morbidity and mortality among acute coronary syndrome (ACS) patients. Prediction score have been used as prognostic to prediction MACE based on risk factor in ACS patients.

Aim: To develop a simple risk score, easily calculated and applicability that can identifies ACS patients with risk for MACE.

Methods: A cohort retrospective study involving 1002 ACS patients in intensive coronary care unit RSCM from January 2010 through December 2013. Sex, age, family history, diabetes, hemoglobin, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest, deviation ST segment and killip class as risk factor for MACE was assessed.

Results: Major Adverse Cardiac Events was found in 112 (9,21%) of ACS patients, predictor factor woman, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest and killip class in multivariate logistic regression analysis were associated with MACE in ACS patients with (RR 95% CI) 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), and 6.31 (3.19-12.50) respectively, and the best predictive accuracy for MACE was obtained by area under curve 0,95, 95% CI, 0,93-0,97.

Conclusions: In ACS patients we found probability MACE was 3,6% in patients with total score 0-6 and 83,5% for who have total score > 6 based on predictor factor woman (score 1), leukocytosis (score 1), elevated creatinine level (score 1), hyperuricemia (score 2), elevated cardiac enzyme (score 1), hypotension (score 2), tachycardia (score 1), cardiac arrest (score 5) and killip class III-IV (score 3)."

"Latar Belakang: Respon antar-individu yang bervariasi terhadap obat antiplatelet (clopidogrel) telah dilaporkan. Perbedaan tingkat metabolisme clopidogrel untuk metabolit aktif tiol menggambarkan variabilitas antar-individu dalam penghambatan trombosit. Sitokrom P4502C19 (CYP2C19) memetabolisme zat metabolit aktif tiol. Carier polimorfisme yang menyebabkan hilangnya fungsi CYP2C19 * 2 dan * 3 alel pada terapi antiplatelet mengakibatkan berkurangnya penghambatan agregasi trombosit. Informasi mengenai hubungan antara CYP2C19 * 2 dan * 3 dengan inhibisi agregasi trombosit pada pasien Sindroma koroner akut di Indonesia masih terbatas. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara dua varian, CYP2C19 * 2 (6816>A) dan CYP2C19 * 3 (636G>A) terhadap penurunan fungsi inhibisi agregasi trombosit. Bahan dan Metode: Desain penelitian cross sectional. Jumlah responden adalah 114 orang (dipilih berdasarkan kriteria inklusi dan kriteria ekslusi). Pemeriksaan polimorfisme CYP2C19 dilakukan dengan menggunakan teknik Real Time-Polymerase Chain Reaction (RT-PCR) TaqMan SNP Genotyping Assays dengan alat dari applied Biosystems 7500 Fast/7900HT Fast Real Time PCR Systems (in standart or 9600 emulation mode). Inhibisi agregasi trombosit diperiksa dengan menggunakan metode Light Transmisi Aggregometry (LTA) dengan alat Helena AggGRAM Analyzer pada penambahan 5umol/L ADP sebagai agregator. Hasil: Distribusi inhibisi agregasi trombosit menunjukkan perbedaan rerata antara responden non carier polimorfisme dengan responden carier polimorfisme (16,9 CI95%: 12,1-21,6 vs 9,4 CI95%: 2,9 - 15,0). Analisis regresi linier menunjukkan bahwa responden carier polimorfisme memiliki inhibisi agregasi trombosit lebih rendah dibandingkan dengan responden non carier polimorfisme. Analisis regresi logistik menunjukkan bahwa responden carier polimorfisme mempunyai odds untuk merespon kurang baik terhadap clopidogrel sebesar 1,9 kali jika dibandingkan dengan responden yang non carier setelah dikontrol oleh variabel umur dan jenis kelamin, hal tersebut mengindikasikan bahwa carier polimorfisme mempunyai inhibisi yang rendah terhadap agregasi trombosit. Kesimpulan: Temuan kami membuktikan adanya hubungan antara CYP2C19 * 2 dan * 3 polimorfisme dengan inhibisi agregasi trombosit.

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Background: Inter-individual variability in response to antiplatelet drugs (clopidogrel) has been reported. The difference in the extent of metabolism of clopidogrel to its active metabolite tiol is the most plausible mechanism for the observed inter-individual variability in platelet inhibition. The cytochrome P4502C19 (CYP2C19) metabolizes the active metabolite tiol. The carrier polymorphisms of reduced - functions of CYP2C19*2 and *3 allele on antiplatelet therapy showed diminished platelet aggregation inhibition. There is limited information on the association between CYP2C19 *2 and *3 with platelet aggregation inhibition in ACS patients generally in Indonesia Population. The aim of this study was to determine the association between two variants, CYP2C19*2 (6816>A) and CYP2C19*3 (636G>A) reduced function with platelet aggregation inhibition.

Material & Method: a cross sectional study was done with 114 subjects (selected by inclusions and exclusions criteria). The CYP2C19 polymorphisms were genotype using the PCR method with TaqMan SNP Genotyping Assays from applied Bio systems 7500 Fast/7900HT Fast Real Time PCR Systems (in standard or 9600 emulation mode). The platelet aggregation inhibition was tested using Light Transmission Aggregometry (LTA) by Helena AggGRAM Analyzer with 5umol/L ADP as aggregator.

Results: The distribution of platelet inhibition aggregation showed difference between respondents with non-carrier polymorphisms and carrier polymorphisms (16,9 CI95%: 12,1 -21,6 vs 9,4 CI95%: 2,9 - 15,0). The linier regression analysist indicated that the carrier polymorphisms have lowest platelet aggregation inhibition compared with non-carrier polymorphisms. The logistic regression analysis indicated that carrier polymorphisms respondents has 1,9 odds to be low response to clopidogrel if compared with non-carrier polymorphisms respondents after adjusted with age and sex and it is indicated that it has low platelet aggregation inhibition.

Conclusion: Our present findings the evidence of an association between CYP2C19 *2 and *3 polymorphisms and platelet aggregation inhibition."

"[ABSTRAKLatar Belakang : Kejadian mortalitas dan MACE merupakan komplikasi pasca PCI yang seringkali terjadi. Kemampuan ahli dalam memprediksi komplikasi dengan cara melakukan stratifikasi risiko menggunakan skor risiko. New Mayo Clinic Risk Score (NMCRS) menggunakan tujuh variabel yang mudah didapatkan pada data awal pasien dan memiliki performa yang baik. Belum ada studi untuk karakteristik mortalitas dan MACE pada NMCRS di ICCU RSCM.Tujuan : mengetahui insidens mortalitas dan MACE serta karakteristik NMCRS pada pasien pasca PCI selama perawatan di ICCU RSCM.Metode : Penelitian dengan desain kohort retrospektif terhadap 313 pasien SKA pasca PCI di ICCU RSCM, dalam kurun waktu 1 Agustus 2013? 31 Agustus 2014. Data pasien dari rekam medis dimasukkan ke dalam tujuh variabel skor NMCRS kemudian ditentukan hasil setiap kategori risiko.Hasil : Insidens mortalitas pasien pasca PCI selama perawatan 3,8% (IK 95% 2,6;5) dan MACE pasca PCI selama perawatan 8,3% (IK 95% 6,6;10). Pasien-pasien dengan usia yang semakin tua, fraksi ejeksi ventrikel kiri yang rendah, infark miokard, kreatinin serum yang meningkat, adanya syok kardiogenik pra prosedur, dan adanya penyakit arteri perifer memiliki kejadian mortalitas dan MACE yang lebih tinggi pasca PCI. Skor NMCRS untuk mortalitas menunjukkan kategori risiko sangat rendah 167 pasien (53%), risiko rendah 60 pasien (19%), sedang 47 pasien (15%), tinggi 10 pasien (3%) dan risiko sangat tinggi 29 pasien (9%). Kejadian mortalitas pada kategori risiko sangat rendah 2 kasus (1,2%), rendah 0 pasien, sedang 2 pasien (4,25%), tinggi 1 pasien (10%) dan sangat tinggi 7 kasus (24,13%). Skor NMCRS untuk MACE memberikan hasil kategori sangat rendah 101 pasien (32%), risiko rendah 128 pasien (41%), sedang 52 pasien (17%), tinggi 16 pasien (5%) dan sangat tinggi 16 kasus (5%). Kejadian MACE untuk risiko sangat rendah sebanyak 4 kasus (3,96%), rendah 7 pasien (5,46%), sedang 4 pasien (7,69%), tinggi 5 pasien (31,25%) dan risiko sangat tinggi 6 kasus (37,5%).Kesimpulan : insidens mortalitas pasien pasca PCI selama perawatan 3,8% (IK 95% 2,6;5) dan MACE pasca PCI selama perawatan 8,3% (IK 95% 6,6;10). Kenaikan skor NMCRS maka akan diiringi peningkatan kejadian mortalitas dan MACE pasca PCI.

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ABSTRACTBackground : Mortality and MACE was an often complication post PCI. Capability from an expert in predict complication by doing risk stratification using risk score. New Mayo Clinic Risk Score (NMCRS) using seven variables easy to collect from medical record and had a good performance. No report about mortality and MACE studies NMCRS characteristic for post PCI patients in ICCU RSCM.Objective : To obtain mortality and MACE incidence and also NMCRS characteristic on post PCI patients in ICCU RSCM.Methods : A retrospective cohort study was conducted to evaluate 313 post PCI patients in ICCU RSCM between August 1st 2013 and August 31 2014. Patients data from medical records collect for seven variables and determined category results for each risk category.Results : In-hospital mortality post PCI incidence 3,8% (CI 95% 2,6;5) and inhospital MACE post PCI 8,3% (CI 95% 6,6-10). Patients that getting older, lower left ventricular ejection fraction, increase serum creatinine, pre-procedure cardiogenic shock, myocardial infarct and peripheral arterial disease had higher mortality and MACE post PCI. NMCRS in predict risk of mortalitas shown for very low risk 167 patient (53%), low risk 60 patient (19%), moderate risk 47 patient (15%), high risk 10 patient (3%) and very high risk 29 patient (9%). Mortality in very low risk 2 patient (1,2%), low risk no patient, moderate 2 patient (4,25%), high 1 patient (10%) and very high risk 7 patient (24,13%). NMCRS in predict MACE shown for very low risk 101 patient (32%), low risk 128 patient (41%), moderate 52 patient (17%), high 16 patient (5%) very high risk 16 patient (5%). MACE in very low risk 4 patient (3,96%), low risk 7 patient (5,46%), moderate risk 4 patient (7,69%), high risk 5 patient (31,25%) and very high risk 6 patient (37,5%).Conclusion : In-hospital mortality post PCI incidence 3,8% (CI 95% 2,6;5) and in-hospital MACE post PCI incidence 8,3% (CI 95% 6,6;10). The increase of NMCRS score was also followed with the increase of mortality and MACE post PCI.;Background : Mortality and MACE was an often complication post PCI. Capability from an expert in predict complication by doing risk stratification using risk score. New Mayo Clinic Risk Score (NMCRS) using seven variables easy to collect from medical record and had a good performance. No report about mortality and MACE studies NMCRS characteristic for post PCI patients in ICCU RSCM.Objective : To obtain mortality and MACE incidence and also NMCRS characteristic on post PCI patients in ICCU RSCM.Methods : A retrospective cohort study was conducted to evaluate 313 post PCI patients in ICCU RSCM between August 1st 2013 and August 31 2014. Patients data from medical records collect for seven variables and determined category results for each risk category.Results : In-hospital mortality post PCI incidence 3,8% (CI 95% 2,6;5) and inhospital MACE post PCI 8,3% (CI 95% 6,6-10). Patients that getting older, lower left ventricular ejection fraction, increase serum creatinine, pre-procedure cardiogenic shock, myocardial infarct and peripheral arterial disease had higher mortality and MACE post PCI. NMCRS in predict risk of mortalitas shown for very low risk 167 patient (53%), low risk 60 patient (19%), moderate risk 47 patient (15%), high risk 10 patient (3%) and very high risk 29 patient (9%). Mortality in very low risk 2 patient (1,2%), low risk no patient, moderate 2 patient (4,25%), high 1 patient (10%) and very high risk 7 patient (24,13%). NMCRS in predict MACE shown for very low risk 101 patient (32%), low risk 128 patient (41%), moderate 52 patient (17%), high 16 patient (5%) very high risk 16 patient (5%). MACE in very low risk 4 patient (3,96%), low risk 7 patient (5,46%), moderate risk 4 patient (7,69%), high risk 5 patient (31,25%) and very high risk 6 patient (37,5%).Conclusion : In-hospital mortality post PCI incidence 3,8% (CI 95% 2,6;5) and in-hospital MACE post PCI incidence 8,3% (CI 95% 6,6;10). The increase of NMCRS score was also followed with the increase of mortality and MACE post PCI., Background : Mortality and MACE was an often complication post PCI. Capability from an expert in predict complication by doing risk stratification using risk score. New Mayo Clinic Risk Score (NMCRS) using seven variables easy to collect from medical record and had a good performance. No report about mortality and MACE studies NMCRS characteristic for post PCI patients in ICCU RSCM.Objective : To obtain mortality and MACE incidence and also NMCRS characteristic on post PCI patients in ICCU RSCM.Methods : A retrospective cohort study was conducted to evaluate 313 post PCI patients in ICCU RSCM between August 1st 2013 and August 31 2014. Patients data from medical records collect for seven variables and determined category results for each risk category.Results : In-hospital mortality post PCI incidence 3,8% (CI 95% 2,6;5) and inhospital MACE post PCI 8,3% (CI 95% 6,6-10). Patients that getting older, lower left ventricular ejection fraction, increase serum creatinine, pre-procedure cardiogenic shock, myocardial infarct and peripheral arterial disease had higher mortality and MACE post PCI. NMCRS in predict risk of mortalitas shown for very low risk 167 patient (53%), low risk 60 patient (19%), moderate risk 47 patient (15%), high risk 10 patient (3%) and very high risk 29 patient (9%). Mortality in very low risk 2 patient (1,2%), low risk no patient, moderate 2 patient (4,25%), high 1 patient (10%) and very high risk 7 patient (24,13%). NMCRS in predict MACE shown for very low risk 101 patient (32%), low risk 128 patient (41%), moderate 52 patient (17%), high 16 patient (5%) very high risk 16 patient (5%). MACE in very low risk 4 patient (3,96%), low risk 7 patient (5,46%), moderate risk 4 patient (7,69%), high risk 5 patient (31,25%) and very high risk 6 patient (37,5%).Conclusion : In-hospital mortality post PCI incidence 3,8% (CI 95% 2,6;5) and in-hospital MACE post PCI incidence 8,3% (CI 95% 6,6;10). The increase of NMCRS score was also followed with the increase of mortality and MACE post PCI.]"