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"Sindrom koroner akut (SKA) merupakan salah satu kegawatan kardiovaskular diInstalasi Gawat Darurat (IGD). Tatalaksana SKA yang ada saat ini membutuhkan waktuminimal 3 jam untuk menentukan apakah pasien dirawat atau dipulangkan, hal ini akanberdampak pada kepadatan IGD dan pemborosan biaya perawatan. European Society ofCardiology merekomendasikan algoritma 0/1 jam pada pasien dengan gambaran EKGnon elevasi segmen ST (NEST) dengan menggunakan high sensitive troponin T (hscTnT)dalam menegakkan atau penapisan infark miokard akut non elevasi segmen ST(IMA-NEST). Penelitian ini bertujuan untuk membandingkan nilai diagnostik hs-cTnTjam ke-1 dan jam ke-3 pada terduga SKA non elevasi segmen ST dengan awitan nyeridada kurang dari 6 jam. Desain penelitian potong lintang. Sebanyak 100 subjekpenelitian yang diambil secara konsekutif sampling. Sensitivitas, spesifisitas, nilaiprediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/1 jam secara berurutanadalah 93,75%, 98,81%, 93,75%, 98,81%, sementara sensitivitas, spesifisitas, nilaiprediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/3 jam secara berurutanadalah 87,50%, 96,81%, 93,33% 97,65%. Pemeriksaan hs-cTnT 0/1 jam dapatdipergunakan dalam rule in dan rule out terduga IMA-NEST dengan awitan nyeri dadakurang dari 6 jam.

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Acute coronary syndrome (ACS) is one of the cardiovascular events in an EmergencyInstallation (ED). The patients management of ACS required at least 3 hours todetermined whether the patient hospitalized or outpatient, these would increased EDscrowded and high cost treatment. The European Society of Cardiology recommended a0/1 hour algorithm in patients with ECG showed non ST segment elevationusing highsensitive troponin T (hs-cTnT) parameter to rule in or rule out non ST segmentelevation myocard infarct (NSTEMI).We aimed to compare diagnostic values of hscTnTat the 1st and 3rd hour in NSTEMI with chest pain onset less than 6 hours. Studydesign was cross sectional. A total of 100 subjects enrolled by consecutive samplingmethod. Sensitivity, specificity, positive predictive value, and negative predictive valueof hs-cTnT 0/1 hours were 93.75%, 98.81%, 93.75%, 98.81%, while sensitivity,specificity, positive predictive value, and the negative predictive value of hs-cTnT 0/3hours were 87.50%, 96.81%, 93.33%, 97.65%. Hs-cTnT 0/1 hour test can be used inrule in and rule out suspect NSTEMI with the chest pain onset less than 6 hours."

"Sindrom koroner akut (SKA) merupakan masalah utama penyakit jantung yang merupakan penyebab kematian tertinggi setelah stroke di Indonesia. SKA dapat dinilai keparahannya melalui skor Gensini dan prognosisnya melalui kejadian Major Adverse Cardiac Event (MACE). High Sensitive Troponin T (hsTroponin T) adalah biomarker yang direkomendasikan beberapa badan internasional dalam mendiagnosis infark miokard. Pada pasien SKA yang disertai penyakit ginjal kronik (PGK) akan mempengaruhi hasil pemeriksaan hsTroponin T. Hal ini disebabkan oleh kadar ureum darah yang tinggi bersifat toksik dan kondisi PGK menurunkan fungsi ginjal sehingga mempengaruhi kadar hsTroponin T. Penelitian ini bertujuan mengetahui hubungan hstroponin T dan ureum dengan skor Gensini, MACE jangka pendek pada pasien SKA yang disertai PGK di RSUPN dr. Cipto Mangunkusumo. Metode penelitian adalah potong lintang dilakukan pada bulan Januari-Oktober 2018. Subjek penelitian meliputi seluruh pasien yang mengikuti penelitian terdahulu “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”. Kadar hsTroponin T dan ureum subjek SKA dengan PGK dihubungkan dengan skor Gensini dan kejadian MACE jangka pendek. Terdapat 80 subjek SKA dengan PGK, terdiri dari 63 subjek STEMI -NSTEMI dengan peningkatan hsTroponin T dan 17 subjek UAP. Terdapat 34 subjek mengalami MACE diantaranya ada 11 subjek yang meninggal. Tidak terdapat korelasi kadar hsTroponin T dengan skor Gensini, r = 0,095, p=0,401 dan juga ureum dengan skor Gensini, r = 0,107, p = 0,343. Peningkatan kadar hsTroponin T memberikan peningkatan Odds Ratio (OR) sebesar 1,59 dan ureum OR 3,14 dengan p<0,05 terhadap kejadian MACE jangka pendek. Titik potong hsTroponin T terhadap kejadian MACE jangka pendek sebesar 150,5ng/L dengan sensitivitas 53,5%, spesifisitas 55,3%, nilai prediksi positif (NPP) 48%, nilai prediksi negatif (NPN) 63,33%. Titik potong ureum terhadap kejadian MACE jangka pendek 47,45mg/dL dengan sensitivitas 52,9%, spesifisitas 47,8%, NPP 63,63%, NPN 63,79%. Berdasarkan hasil tersebut peningkatan kadar hsTroponin T diatas 150,5ng/L dan ureum47,45mg/dL berperan dalam meningkatkan risiko kejadian terjadinya MACE jangka pendek dengan OR 1,59 dan 3,14 pada pasien SKA dengan PGK. Gambaran kadar hsTroponin T bervariasi pada setiap stadium PGK tetapi ada kecenderungan peningkatan kadar seiring dengan peningkatan stadium PGK, untuk itu diperlukan penelitian lebih lanjut untuk mendapatkan gambaran kadar hsTroponin T yang lebih jelas.

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Acute Coronary Syndrome(ACS) is the main problem in heart disease which is the highest mortality after stroke in Indonesia. ACS can be assess the severity degree by Gensini scoring and its prognosis by Major Adverse Cardiac Event (MACE). High sensitive Troponin T (hsTroponin T) is biomarker that recomended by several international associations in diagnosing miocard infarct. Level of hs Troponin T can be affected in patients with ACS and chronic kidney disease (CKD), because lower filtration in CKD and high level ureum has toxic effect.This research aimed in knowing the relation of hsTroponin T and ureum with Gensini score, short term MACE, in ACS and CKD in RSUPN dr. Cipto Mangunkusumo. Methods using cross sectional in January-October 2018. All patients in elder research “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”, are included in this research, and then search for the correlation between hsTroponin T, ureum and Gensini score, short term MACE. There are 80 subjects ACS with CKD, 63 subjects with STEMI -NSTEMI (ST Elevation Miocard Infarct-Non ST Elevation Miocard Infarct) and elevated level of hs-troponin T, 17 subjects UAP (Unstable Angina Pectoris), 34 subjects MACE and 11 subjects within were died. There is no correlation between hsTroponin T and Gensini score is not , r=0,095 with p=0,401. There is no correlation between ureum and Gensini score r= 0,107 with p=0,343. Level of hsTroponin T and ureum has odds ratio OR= 1,59 and 3,14, p<0,05 towards short term MACE. The cut off for hsTroponin T towards short term MACE is 150,5ng/L with sensitivity 53,5%, specificity 55,3%, positive predictive value (PPV) 48%, negative predictive value (NPV) 63,33%. The cut off for ureum towards short term MACE is 47,45mg/dL with sensitivity 52,9%, specificity 47,8%, PPV 63,63%,NPV 63,79%. The descriptions of hsTroponin T level are various in every stage of CKD. According to that results, ascending level in hsTroponin T with cut off 150,5ng/L and ureum 47,45mg/dL has an impact in short term MACE (OR hsTroponin T=1,59 and ureum=3,14) in patients with ACS and CKD. The descriptions of level hsTroponin T are variety, but have tendency to escalate level hsTroponin T in every stage of CKD and need advance research to have clear descriptions."

"ABSTRAKLatar Belakang. IMA-EST merupakan salah satu manifestasi SKA yang fatal.Terapi reperfusi diindikasikan terhadap pasien dengan IMA-EST dengan awitankurang dari 12 jam. Perdarahan merupakan faktor resiko independen mortalitaspasca IKPP. Perdarahan mayor memperburuk prognosis, meningkatkan lamanyawaktu rawat dan meningkatkan biaya perawatan. Saat ini, penggunaan aksestrans-radial saat IKPP lebih diutamakan dan penghambat Gp2b3a tidak rutindigunakan. Walaupun demikian, kejadian perdarahan pada IMA-EST tetap sajameningkatkan tiga kali lipat resiko kematian. Sampai saat ini belum ada sistempenilaian khusus yang menilai resiko perdarahan pasca IKPP trans-radial.Metode. Penelitian kohort retrospektif dilaksanakan di Rumah Sakit PusatJantung dan Pembuluh Darah Nasional Harapan Kita. Data yang diambilmerupakan kasus IKPP trans-radial pada IMA-EST periode Januari 2011 ndash;Agustus 2016. Definisi perdarahan menggunakan definisi Bleeding AcademicResearch Consortium BARC . Pengolahan data dilakukan dengan analisisbivariat untuk menguji hubungan variabel-variabel independen dengan kejadianperdarahan, lalu dilakukan analisis multivariat. Pemilihan model akhir dilakukandengan metode backward selection dan dilakukan pembobotan untuk membentuksuatu sistem penilaian. Dilakukan validasi internal terhadap sistem penilaian inimenggunakan metode bootsrapping.Hasil. Sejumlah 1035 sampel dikumpulkan, 49 4.7 kasus di antaranyamengalami perdarahan. Didapatkan 6 faktor yang dapat dijadikan prediktorindependen terhadap kejadian perdarahan pasca IKPP trans-radial, yaitu : IMT 2, usia ge; 62 tahun, hitung leukosit ge; 12.000 10/ L,nilai hemoglobin Hb < 13 g/dL, dan nilai kreatinin ge; 1.5 mg/dL. Uji kalibrasidan validasi internal terhadap studi menunjukkan hasil yang baik.Kesimpulan. Sistem penilaian resiko perdarahan pasca IKPP trans-radial inimemiliki hasil uji kalibrasi, uji diskriminasi, dan validasi internal yang cukupbaik. Sistem penilaian ini diharapkan dapat digunakan sebagai salah satu strategipencegahan perdarahan pasca IKPP trans-radial pada kasus IMA-EST.

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ABSTRACTBackground STEMI is a fatal manifestation of acute coronary syndrome.Reperfusion therapy is indicated for acute STEMI patient within less than 12hours rsquo onset of chest pain. Bleeding is an independent mortality risk as acomplication of primary PCI. Major bleeding worsens the prognosis, prolonglength of hospital stay, and increase the cost of care. Nowadays, trans radialaccess during primary PCI is a priority and the use of Gp2b3a inhibitor is nolonger used routinely. However, post primary PCI bleeding event nonethelesstripled the risk of death. Until now, there has been no system of assessments thatmeasure the risk of post primary PCI bleeding in specific trans radial accesspopulation.Method Data from 1035 post trans radial primary PCI STEMI patients enrolledfrom a cohort retrospective study performed in National Cardiovascular CenterHarapan Kita between January 2011 and August 2016. BARC bleeding definitionwas utilized to standardized the identification of bleeding events. Statisticalanalysis done by performing bivariate analysis to identify the relationship of eachvariables to the bleeding event, then multivariate analysis was done using logisticregression before the scoring system developed. Internal validation was performedby bootstrapping tecnique.Results 4.7 from 1035 sample experienced bleeding event. 6 factors related tobleeding event post trans radial primary PCI were identified BMI 18.5 kg m2,KILLIP class 2, age ge 62, WBC ge 12.000 10 3 L, hemoglobin 13 g dL, andcreatinine ge 1.5 mg dL. Calibration test and internal validation of this studyshowing good result.Conclusion This trans radial Primary PCI bleeding risk score has a good resultof calibration test, discrimination test, and internal validation. This scoring systemis expected to be applied as one of bleeding avoidance strategies in trans radialprimary PCI in STEMI patients."

"Latar Belakang : Deteksi infark pada populasi sindroma koroner akut non elevasi segmen ST (SKA-NEST) pada praktik klinis sulit dan menyebabkan kegagalan stratifikasi risiko yang tepat. Pemeriksaan enzim jantung tidak tersedia secara luas, memiliki waktu tunggu yang lama, dan membutuhkan biaya yang tidak sedikit.Tujuan : Mengetahui akurasi dasar dan akurasi paska training kecerdasan buatan Learning Intelligent for Effective Sonography (LIFES) dalam mendeteksi infark miokard pada populasi SKA-NEST berdasarkan gambaran ekokardiografiMetode : Penelitian ini merupakan studi diagnostik yang mengevaluasi kemampuan kecerdasan buatan berbasis deep learning LIFES dalam mendeteksi infark miokard pada pasien SKA-NEST di RSJPDHK pada tahun 2019-2023 berdasarkan gambaran ekokardiografi. Dilakukan transfer learning menggunakan dataset penelitian dan cross validation untuk mengetahui tingkat akurasi model baru paska transfer learning.Hasil : Sebanyak 721 subjek memenuhi kriteria inklusi dan eksklusi dari tahun 2019-2023. 310 diantaranya adalah pasien infark miokard non elevasi segmen ST (IMA-NEST). Sebanyak 67,8 % subjek adalah laki-laki dengan median usia 61 tahun. Median waktu dilakukan ekokardiografi dari admisi adalah tiga hari. Terdapat perbedaan signifikan pada beberapa parameter ekokardiografi pada kelompok infark vs non infark berupa median FEVKi 53% vs 63 % (p < 0,001), median LVEDD 48,8 mm vs 44,6 mm (p < 0,001), median rerata E/E’ 12,0 vs 9,8 (p < 0,001) dan median LAVI 30 ml/m2 vs 26 ml/m2 (p < 0,001). Performa diagnostik LIFES terhadap infark didapatkan paling baik pada tampilan PLAX dengan sensitivitas 88,7 % dan spesifisitas 20,4 % AUC 0,55 pada LIFES fase 2 model 1. Paska transfer learning, model LIFES-MI menghasilkan akurasi terbaik pada tampilan A4C dengan sensitivitas 41,3 % dan spesifisitas 83,7% AUC 0,61.Kesimpulan Model kecerdasan buatan LIFES fase 2 model 1 memiliki sensitivitas yang baik untuk deteksi infark miokard, sedangkan model LIFES-MI memiliki spesifisitas yang baik dalam mendeteksi infark miokard berdasarkan gambaran ekokardiografi pada populasi SKA-NEST.

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Background: Detecting myocardial infarction in the non-ST segment elevation acute coronary syndrome (NSTEACS) population in clinical practice is challenging and leads to failure in appropriate risk stratification. Cardiac enzyme assays are not widely available, have long waiting times, and incur significant costs.

Objective: To determine the baseline accuracy and post-training accuracy of the Learning Intelligent for Effective Sonography (LIFES) artificial intelligence in detecting myocardial infarction in the NSTEACS population based on echocardiographic findings.

Method: This study is a diagnostic study that evaluates the ability of deep learning-based artificial intelligence LIFES in detecting myocardial infarction in NSTEACS patients at RSJPDHK from 2019 to 2023 based on echocardiographic videos.. Transfer learning was performed using the research dataset and cross-validation to determine the accuracy level of the new model post-transfer learning.

Results: A total of 721 subjects met the inclusion and exclusion criteria from 2019 to 2023. Among them, 310 were non-ST segment elevation myocardial infarction (NSTEMI) patients. 67.8% of the subjects were male with a median age of 61 years. The median time from admission to echocardiography was three days. There were significant differences in several echocardiographic parameters between the infarct and non-infarct groups, including median EF% 53% vs 63% (p < 0.001), median LVEDD 48.8 mm vs 44.6 mm (p < 0.001), median mean E/E' 12.0 vs 9.8 (p < 0.001), and median LAVI 30 ml/m2 vs 26 ml/m2 (p < 0.001). LIFES diagnostic performance for infarction was best achieved in the PLAX view with sensitivity of 88.7% and specificity of 20.4%, AUC 0.55 in LIFES phase 2 model 1. Post-transfer learning, the LIFES-MI model produced the best accuracy in the A4C view with sensitivity of 41.3% and specificity of 83.7%, AUC 0.61.

Conclusion: The Learning Intelligent for Effective Sonography (LIFES) phase 2 model 1 has good sensitivity for detecting myocardial infarction, while the LIFES-MI model has good specificity in detecting myocardial infarction based on echocardiographic findings in the NSTEACS population."

"Latar Belakang : Pasien infark miokard akut dengan elevasi segmen ST IMAEST yang mengalami revaskularisasi dengan intervensi koroner perkutan primer IKPP dapat terjadi cedera reperfusi yang mempengaruhi prognosis. Penelitianpada model hewan menunjukkan ticagrelor melindungi jantung dari cederareperfusi, namun demikian belum ada penelitian pada manusia yang menguji halini. Tujuan : Membandingkan pengaruh antara ticagrelor dengan clopidogrelterhadap cedera reperfusi yang diukur melalui kadar puncak high sensitivetroponin T hs-cTnT pada pasien IMA-EST yang mengalami revaskularisasi. Metode : Penelitian ini merupakan penelitian eksperimental acak tersamar gandayang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita padabulan Agustus 2016 sampai November 2016. Pasien IMA-EST yang akanmenjalani IKPP dirandomisasi ke dalam dua kelompok yaitu kelompok yangmendapatkan loading ticagrelor 180 mg dilanjutkan dosis rumatan 2x90 mg danyang mendapatkan loading clopidogrel 600 mg dilanjutkan dosis rumatan 1x75mg sebelum IKPP. Dilakukan pemeriksaan hs-cTnT 8 jam pasca dilatasi balonkateter pertama. Hasil Penelitian : Terdapat total 60 subyek, 30 subyek kelompok ticagrelor dan30 subyek kelompok clopidogrel. Tidak ditemukan perbedaan bermakna antaraticagrelor dengan clopidogrel terhadap kadar puncak hs-cTnT 9026 5026 ng/Lvs 9329 4664 ng/L, nilai p 0,809. Kesimpulan : Ticagrelor tidak menyebabkan kadar puncak high sensitivetroponin T yang lebih rendah bila dibandingkan dengan clopidogrel pada pasienIMA-EST yang mengalami revaskularisasi.

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Background : Reperfusion injury influence prognosis in ST elevation myocardialinfarction STEMI patients after primary percutaneous coronary intervention PPCI . Previous study on animal models showed that ticagrelor may haveprotective effect on the heart by reducing reperfusion injury. However, no studyon humans has ever been done to confirm this.

Aim : To compare the effect of ticagrelor with clopidogrel on reperfusion injurycalculated by peak high sensitive troponin T hs cTnT in STEMI patients whounderwent revascularization.

Methods : This was a randomized controlled trial done in NationalCardiovascular Center Harapan Kita from August 2016 to November 2016.STEMI patients who underwent PPCI was randomized to either ticagrelor loadingdose 180 mg with maintenance of 2x90 mg or clopidogrel loading dose 600 mgwith maintenance of 1x75mg group. Peak hs Troponin T was measured 8 hoursafter first balloon dilatation.

Results : Sixty subjects was included in the study, 30 subjects in the ticagrelorgroup and 30 subjects in the clopidogrel group. There were no difference betweenticagrelor vs clopidogrel on peak hs cTnT levels 9026 5026 ng L vs 9329 4664 ng L, p value 0,809.

Conclusion : Ticagrelor does not cause a lower peak high sensitive troponin Tlevel compared to clopidogrel in STEMI patients who underwentrevascularization."

"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."

"Latar Belakang: Disfungsi diastolik signifikan (derajat 2 dan 3) merupakan komplikasi yang relatif sering ditemukan dan prediktor mortalitas independen pada sindrom koroner akut (SKA). Pemeriksaan ekokardiografi untuk evaluasi disfungsi diastolik tidak selalu dapat dilakukan dan tidak tersedia luas di berbagai tingkat fasilitas pelayanan kesehatan. Pemeriksaan elektrokardiogram (EKG) lebih luas tersedia dan telah ditunjukkan pada penelitian sebelumnya memiliki nilai diagnostik sebagai skrining disfungsi diastolik pada pasien hipertensi dan penyakit ginjal kronikTujuan: Tujuan penelitian ini untuk menilai apakah parameter EKG waktu puncak gelombang P (PWPT) dan waktu dari puncak hingga akhir gelombang T (Tp-e) dapat digunakan sebagai skrining disfungsi diastolik signifikan pada pasien sindrom koroner akut.Metode: Data sekunder (ekokardiogram dan EKG yang diperiksakan pada hari yang sama) dari 93 pasien SKA yang dirawat di ruang rawat intensif koroner dari Januari 2020 hingga Januari 2021 dianalisis dalam studi cross-sectional ini. PWPTV1 didefinisikan sebagai waktu dari awal gelombang P hingga mencapai puncaknya (diukur di sandapan V1). Tp-e didefinisikan sebagai waktu dari puncak gelombang T hingga akhir gelombang T (diukur di V5). Peneliti yang menilai EKG tidak mengetahui hasil ekokardiogram (blinding). Parameter EKG dan variabel lain dibandingkan di antara grup SKA dengan dan tanpa disfungsi diastolik signifikan.Hasil: Terdapat 32,3% pasien SKA dengan disfungsi diastolik signifikan. Durasi PWPTV1 memanjang pada kelompok SKA dengan disfungsi diastolik signifikan (65 vs. 59 miliseconds, p<0.01). PWPTV1 memiliki korelasi dengan indeks volume atrium kiri (LAVI) (r=0,283, p=0,019) and merupakan prediktor independen terhadap disfungsi diastolik signifikan (OR=1,062, p=0,035). Sebaliknya Tp-e tidak didapatkan memilki perbedaan signifikan diantara kedua kelompok dan tidak berkorelasi dengan parameter disfungsi diastolik pada ekokardiografi. Analisis receiver operating characteristics (ROC) PWPTV1 menunjukkan AUC=0,677 (IK 95% 0.557-0,798), p=0,006 dengan titik potong optimal di 63,5 milidetik yang menunjukkan sensitivitas 60% dan spesifisitas 77,8 persen.Simpulan: Hasil penelitian ini menunjukkan pemanjangan PWPTV1 memiliki nilai diagnostik yang rendah untuk skrining disfungsi diastolik signifikan pada pasien sindrom koroner akut.

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Background: Significant diastolic dysfunction (grade 2 and 3) is a relatively common complication and an independent predictor of mortality in acute coronary syndrome (ACS). Evaluation of diastolic function by echocardiography is not always feasible and accessible throughout all levels of healthcare facilities. Electrocardiogram (ECG) test is more readily available and has been shown in previous studies to have a diagnostic value to screen for diastolic dysfunction in hypertensive and chronic kidney disease (CKD) patients.

Objective: The purpose of this study is to examine whether ECG indices P wave peak time (PWPT) and T wave peak to T wave end (Tp-e) can be used as an aid to screen for significant diastolic dysfunction in patients with acute coronary syndrome.

Methods: Secondary data (echocardiogram and ECG on the same day) of 93 ACS patients admitted to the intensive coronary care unit (ICCU) from January 2020 to January 2021 were analyzed in this cross-sectional study. PWPTV1 was defined as the time from begining of P wave to its peak (meassured in lead V1). Tp-e was defined as the time from begining of T wave peak to its end (meassured preferably in lead V5). ECG evaluator was blinded to the echocardiogram results. ECG indices and other variables were compared between groups of ACS patients with and without significant diastolic dysfunction.

Results: Significant diastolic dysfunction was present in 32,3% of ACS patients. PWPTV1 was significantly prolonged in the significant diastolic dysfunction group (65 vs. 59 miliseconds, p<0.01). PWPTV1 has significant correlation with left atrial volume index (LAVI) (r=0,283, p=0,019) and was found to be an independent predictor of significant diastolic dysfunction (OR=1,062, p=0,035). Tp-e on the other hand showed no difference between the two groups and was not correlated with echocardiography diastolic dysfunction indices. Receiver operating characteristics (ROC) analysis of PWPTV1 showed AUC=0,677 (IK 95% 0.557-0,798), p=0,006 with optimal cut off point of 63,5 miliseconds which showed 60% sensitivity and 77,8% specificity.

Conclusion: In this study prolonged PWPTV1 was shown to have low diagnostic value to screen for significant diastolic dysfunction in ACS patients"

"ABSTRAK Diagnosis infark miokard akut ditegakkan apabila memenuhi 2 dari 3 kriteria, yaitu klinis, perubahan EKG, dan peningkatan kadar penanda biokimia jantung. Troponin merupakan penanda biokimia jantung yang spesifik untuk infark miokard, akan tetapi memiliki keterbatasan yaitu kurang sensitif apabila dilakukan pada fase awal karena troponin akan meningkat dalam darah setelah 4 -10 jam setelah infark miokard. Copeptin merupakan penanda stres endogen, yang dapat meningkat pada awal onset infark miokard akut, namun kurang spesifik. Penelitian tentang copeptin-us sebagai penanda biokimia jantung masih sedikit dan di Indonesia penelitian tentang copeptin-us sebagai penanda biokimia jantung belum pernah dilakukan.Penelitian ini mengikutsertakan 91 pasien tersangka sindrom koroner akut yang terbagi atas 15 (16,5%) NSTEMI, 43 (47,3%) UA, dan 33 (36,3%) non SKA. Diagnosis ditegakkan oleh dokter di IGD RS Jantung dan Pembuluh Darah Harapan Kita. Karakteristik pasien yang memenuhi kriteria inklusi dan eksklusi dicatat dan kemudian dilakukan pemeriksaan copeptin-us.Nilai rerata copeptin-us pada NSTEMI adalah 151,80 ± 130,03 pmol/L, median copeptin-us pada UA adalah 7,12(1,145 ? 62,23) pmol/L, dan rerata copeptin-us pada non SKA adalah 7,36 ± 4,17 pmol/L. Nilai cut off copeptin-us untuk membedakan NSTEMI dengan UA/non SKA adalah 13,97 pmol/L. Area under curve (AUC) kombinasi hs-cTnT saat masuk rumah sakit dengan copeptin-us adalah 0,941 (0,882 ? 1,00), hs-cTnT saat masuk rumah sakit 0,885 (0,790 ? 0,98), dan AUC hs-cTnT 3 jam kemudian adalah 0,925 (0,824 ? 1,00). Nilai median hs-cTnT saat masuk RS pada NSTEMI adalah 114(29-1102) pg/mL, pada UA adalah 16 (3-3352) pg/mL, dan pada non SKA adalah 6(3-366) pg/mL. Nilai median hs-cTnT 3 jam pada NSTEMI adalah 488 (81-18437) pg/mL, pada UA 14(3-2224) pg/mL, dan pada non SKA adalah 3(3-679) pg/mL. Kombinasi copeptin-us ≥ 13,97 pmol/L dan hs-cTnT ≥ 14 pg/mL dan untuk membedakan NSTEMI dengan UA/non SKA memberikan sensitivitas 100%, spesifisitas 90,78%, NPP 68,18%, dan NPN 100%.Uji diagnostik kombinasi copeptin-us dan hs-cTnT saat masuk RS lebih baik dibandingkan hs-cTnT saat masuk RS saja dan dapat digunakan untuk rule out NSTEMI.ABSTRACT Diagnosis of acute myocardial infarction is made when two of the followed criterias are met; clinical, ECG changes, and increased levels of cardiac biochemical markers. Troponin is a specific cardiac biochemical marker for myocardial infarction but has limitation. It is less sensitive when measured in the early phase, because troponin will increase in blood after 4 -10 hours post myocardial infarction. Copeptin is an endogenous stress marker, it level increases in the early onset of acute myocardial infarction but study on copeptin-us as cardiac biochemical marker are limited and in Indonesia there is no study on copeptin-us has been done.In this study 91 consecutive patients fulfilled the inclusion and exclusion criteria, consist of 15 (16,5%) NSTEMI, 43 (47,3%) unstable angina, and 33 (36,3%) non acute coronary syndrome. Diagnosis was made by the emergency physician at Harapan Kita cardiovascular centre. Characteristics of these subject were recorded and then the copeptin-us levels were measured.The mean value of copeptin-us in NSTEMI is 151,80 ± 130,03 pmol/L, median copeptin-us in UA is 7,12(1,145 ? 62,23) pmol/L, and the mean copeptin-us in non ACS is 7,36 ± 4,17 pmol/L. Cut off value of copeptin-us to distinguish NSTEMI from UA/non ACS is 13,97 pmol/L. Area under curve of the combination hs-cTnT on admission and copeptin-us is 0,941 (0,882 ? 1,00), hs-cTnT on admission is 0,885 (0,790 ? 0,98), and hs-cTnT 3 hours laters is 0,925 (0,824 ? 1,00). Median value hs-cTnT on admission in NSTEMI is 114(29-1102) pg/mL, in UA is 16 (3-3352) pg/mL, and in non ACS is 6(3-366) pg/mL. Median hs-cTnT 3 hours in NSTEMI is 488(81-18437) pg/mL, in UA is 14(3-2224) pg/mL, and in non ACS is 3(3-679) pg/mL. Combination of copeptin-us ≥ 13,97 pmol/L and hs-cTnT ≥14 pg/mL to distinguish NSTEMI from UA/non ACS has sensitivity 100%, specificity 90,78%, PPV 68,18%, and NPV 100%.The diagnostic value of combination on copeptin-us and hs-cTnT is better than only hs-cTnT on admission so that it can be used to rule out NSTEMI.;Diagnosis of acute myocardial infarction is made when two of the followed criterias are met; clinical, ECG changes, and increased levels of cardiac biochemical markers. Troponin is a specific cardiac biochemical marker for myocardial infarction but has limitation. It is less sensitive when measured in the early phase, because troponin will increase in blood after 4 -10 hours post myocardial infarction. Copeptin is an endogenous stress marker, it level increases in the early onset of acute myocardial infarction but study on copeptin-us as cardiac biochemical marker are limited and in Indonesia there is no study on copeptin-us has been done.In this study 91 consecutive patients fulfilled the inclusion and exclusion criteria, consist of 15 (16,5%) NSTEMI, 43 (47,3%) unstable angina, and 33 (36,3%) non acute coronary syndrome. Diagnosis was made by the emergency physician at Harapan Kita cardiovascular centre. Characteristics of these subject were recorded and then the copeptin-us levels were measured.The mean value of copeptin-us in NSTEMI is 151,80 ± 130,03 pmol/L, median copeptin-us in UA is 7,12(1,145 ? 62,23) pmol/L, and the mean copeptin-us in non ACS is 7,36 ± 4,17 pmol/L. Cut off value of copeptin-us to distinguish NSTEMI from UA/non ACS is 13,97 pmol/L. Area under curve of the combination hs-cTnT on admission and copeptin-us is 0,941 (0,882 ? 1,00), hs-cTnT on admission is 0,885 (0,790 ? 0,98), and hs-cTnT 3 hours laters is 0,925 (0,824 ? 1,00). Median value hs-cTnT on admission in NSTEMI is 114(29-1102) pg/mL, in UA is 16 (3-3352) pg/mL, and in non ACS is 6(3-366) pg/mL. Median hs-cTnT 3 hours in NSTEMI is 488(81-18437) pg/mL, in UA is 14(3-2224) pg/mL, and in non ACS is 3(3-679) pg/mL. Combination of copeptin-us ≥ 13,97 pmol/L and hs-cTnT ≥14 pg/mL to distinguish NSTEMI from UA/non ACS has sensitivity 100%, specificity 90,78%, PPV 68,18%, and NPV 100%.The diagnostic value of combination on copeptin-us and hs-cTnT is better than only hs-cTnT on admission so that it can be used to rule out NSTEMI.;Diagnosis of acute myocardial infarction is made when two of the followed criterias are met; clinical, ECG changes, and increased levels of cardiac biochemical markers. Troponin is a specific cardiac biochemical marker for myocardial infarction but has limitation. It is less sensitive when measured in the early phase, because troponin will increase in blood after 4 -10 hours post myocardial infarction. Copeptin is an endogenous stress marker, it level increases in the early onset of acute myocardial infarction but study on copeptin-us as cardiac biochemical marker are limited and in Indonesia there is no study on copeptin-us has been done.In this study 91 consecutive patients fulfilled the inclusion and exclusion criteria, consist of 15 (16,5%) NSTEMI, 43 (47,3%) unstable angina, and 33 (36,3%) non acute coronary syndrome. Diagnosis was made by the emergency physician at Harapan Kita cardiovascular centre. Characteristics of these subject were recorded and then the copeptin-us levels were measured.The mean value of copeptin-us in NSTEMI is 151,80 ± 130,03 pmol/L, median copeptin-us in UA is 7,12(1,145 ? 62,23) pmol/L, and the mean copeptin-us in non ACS is 7,36 ± 4,17 pmol/L. Cut off value of copeptin-us to distinguish NSTEMI from UA/non ACS is 13,97 pmol/L. Area under curve of the combination hs-cTnT on admission and copeptin-us is 0,941 (0,882 ? 1,00), hs-cTnT on admission is 0,885 (0,790 ? 0,98), and hs-cTnT 3 hours laters is 0,925 (0,824 ? 1,00). Median value hs-cTnT on admission in NSTEMI is 114(29-1102) pg/mL, in UA is 16 (3-3352) pg/mL, and in non ACS is 6(3-366) pg/mL. Median hs-cTnT 3 hours in NSTEMI is 488(81-18437) pg/mL, in UA is 14(3-2224) pg/mL, and in non ACS is 3(3-679) pg/mL. Combination of copeptin-us ≥ 13,97 pmol/L and hs-cTnT ≥14 pg/mL to distinguish NSTEMI from UA/non ACS has sensitivity 100%, specificity 90,78%, PPV 68,18%, and NPV 100%.The diagnostic value of combination on copeptin-us and hs-cTnT is better than only hs-cTnT on admission so that it can be used to rule out NSTEMI."

"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."

"Berduka dapat dirasakan oleh pasien SKA yang kehilangan kondisi sehatnya secara tiba-tiba. Berduka bisa menjadi rumit sehingga dapat menurunkan kepatuhan pasien terhadap pengobatan dan meningkatkan resiko kejadian infark berulang dan rehospitalisasi. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan berduka pada pasien yang dirawat pasca SKA. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif analitik, menggunakan pendekatan cross sectional yang melibatkan 132 responden. Analisis data menggunakan analisis deskriptif, uji chi square dan regresi logistik berganda. Karakteristik sosiodemografik responden menunjukkan bahwa sebagian besar berjenis kelamin laki-laki, berpendidikan tinggi, aktif bekerja, dan berstatus menikah. Responden dengan usia ≤ 60 tahun dan > 60 tahun memiliki proporsi yang sama. Berdasarkan karakteristik klinis, sebagian besar responden menjalani rawat inap ≤ 5 hari, tidak memiliki riwayat SKA, memiliki ko-morbid, dan memiliki keterbatasan mobilitas fisik. Sebagian besar responden memiliki dukungan keluarga baik, kecerdasan spiritual baik dan persepsi terhadap penyakit negatif. Hasil dari penelitian ini menunjukkan bahwa sebagian besar responden mengalami berduka yang tinggi. Terdapat hubungan yang signifikan antara ko-morbid (p=0.028), keterbatasan mobilitas fisik (p=0.031), kecerdasan spiritual (p=0.022), dan persepsi terhadap penyakit (p=0.004), dimana persepsi terhadap penyakit adalah faktor yang paling dominan berhubungan dengan berduka, dengan OR 3.362 (CI 95% 1.389-8.134). Pentingnya intervensi keperawatan untuk meningkatkan persepsi terhadap penyakit dan mencegah terjadinya berduka tinggi yang memanjang dan rumit pada pasien SKA.

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Grief can occur in ACS patients who suddenly lose their healthy condition. Grieving can be complicated and can reduce patient compliance with treatment and increase the risk of recurrent infarction and rehospitalization. This study aims to determine factors associated with grieving among hospitalized patients after ACS event. This research is a quantitative research with a descriptive analytical design, using cross sectional approach involving 132 respondents. Data analysis used descriptive analysis, chi-square test and multiple logistic regression. The sociodemographic characteristics of the respondents showed that the majority were men, highly educated, actively working, and married. Respondents aged ≤ 60 years and > 60 years have the same proportion. In clinical characteristics, most of the respondents were hospitalized for ≤ 5 days, had no history of ACS, had co-morbidities, and had limited physical mobility. Most respondents had good family support, good spiritual intelligence and negative perceptions of illness. The results of this research show that the majority of respondents experienced high levels of griving. There is a significant relationship between co-morbidity (p= 0.028), limited physical mobility (p=0.031), spiritual intelligence (p=0.022) and perception of illness (p=0.004), where perception of the illness is the most dominant factor related to grief, with OR 3.362 (CI 95% 1.389-8.134). It is important to provide nursing interventions to improve perceptions of illness and prevent prolonged and complicated grief in ACS patients."