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"Pendahuluan. Sindrom koroner akut (SKA) adalah gangguan yang mengancam jiwa yang tetap menjadi sumber morbiditas dan mortalitas yang tinggi meskipun ada kemajuan dalam pengobatan. Hubungan antara asam urat serum dengan penyakit jantung iskemik masih kontroversial dan belum ditetapkan sebagai faktor risiko kardiovaskular. Interaksi kooperatif antara keduanya tidak sepenuhnya dipahami. Beberapa bukti epidemiologis hubungan kausal tersebut masih kontroversial. Sering sekali penelitian dengan kasus yang sama dan menggunakan metode yang sama tetapi hasilnya berbeda. Penelitian ini bertujuan untuk melakukan meta analisis untuk mensintesis hasil-hasil penelitian yang berbeda tersebut agar diperoleh data baru yang bersifat kuantitatif dan lebih akurat. Metode. Protokol penelitian didaftarkan dengan PROSPERO (CRD42020210948) dan telaah sistematis mengikuti pedoman preferred reporting items for systematic reviews and meta-analyses (PRISMA), dengan menelusuri studi yang dipublikasikan dalam rentan waktu dari Januari 2010 hingga Mei 2020. Cochrane Library, Ebsco, Medline/PubMed, ProQuest dan Sience Direct adalah sumber dari studi yang dipublikasikan. Meta-analisis dilakukan untuk mensintesis korelasi antara kadar asam urat serum dan keparahan stenosis arteri koroner, menggunakan model efek acak untuk menjelaskan kemungkinan heterogenitas penelitian. Heterogenitas dinilai menggunakan I2, dan meta analisis menggunakan perangkat lunak Comprehensive Meta Analysis Version 3 (CMA3).Hasil. Lima studi (n = 601 pasien) diidentifikasi didapatkan korelasi antara kadar asam urat serum dan skor Gensini (r = 0,548; p <0,001) pada pasien SKA. Bias heterogenitas ditemukan dalam analisis, sedangkan bias publikasi tidak ditemukan.Simpulan. Keparahan stenosis arteri koroner pada pasien dengan SKA berkorelasi positif dengan kadar asam urat serum.

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Introduction. Acute coronary syndrome (ACS) is a life-threatening disease which remains a source of high morbidity and mortality despite advances in treatment. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different. This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately.

Methods. The study protocol was registered in PROSPERO (CRD42020210948) and systematic study follows the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA), tracing studies published in January 2010 to May 2020. Sources of database using Cochrane Library, Ebsco, Medline/PubMed, ProQuest and Science Direct. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis. Heterogeneity was assessed using I2, and the meta-analysis was performed using Comprehensive Meta Analysis Version 3 (CMA3) software.

Results. Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis, whereas publication bias was not found.

Conclusion. The severity of coronary artery stenosis in patients with ACS is positively correlated with serum uric acid levels."

"Prevalensi Sindrom Koroner Akut (SKA) yang merupakan penyakit jantung iskemik paling kritis menjadi sumber utama morbiditas dan mortalitas di seluruh dunia, meningkat secara signifikan setiap tahunnya di Indonesia termasuk Bali pada kelompok usia dewasa muda. Identifikasi faktor resiko yang bisa dimodifikasi seperti kebiasaan merokok, mengonsumsi minuman beralkohol dan makanan olahan yang membudaya menjadi bagian penting untuk pembuatan strategi pencegahan primer, terjadinya serangan dan pencegahan sekunder mengurangi readmision. Penelitian ini bertujuan mengidentifikasi faktor yang dapat dimodifikasi berhubungan dengan kejadian SKA usia dewasa muda di Bali. Penelitian kuantitatif ini menggunakan desain cross sectional dengan studi deskriptif-analitik, dan teknik consecutive sampling pada 150 responden sesuai kriteria inklusi. Hasil penelitian menunjukkan terdapat hubungan signifikan antara Hipertensi, Diabetes Mellitus, Dislipidemia, Hiperuresemia, Diet, Aktivitas fisik, Obesitas, Merokok, Konsumsi Alkohol, Stres, dan Kualitas Tidur. Faktor yang paling berhubungan dengan kejadian SKA pada dewasa muda di Bali adalah Hipertensi (OR=6,785). Rekomendasi diharapkan penelitian lanjutan terkait faktor lain yang dapat mempengaruhi kejadian SKA dewasa muda di Bali seperti kardiososial serta strategi pencegahan dan pengendalian berbasis budaya Bali.

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The prevalence of acute coronary syndrome (ACS), which is the most critical ischemic heart disease and the main source of morbidity and mortality in the world, it increases significantly every year in Indonesia, including young adult in Bali. Modifiable risk factors, such as the habit smoking habits, consuming alcohol drinks and processed foods is an important part of primary prevention strategy of attacks and secondary prevention of reducing readmissions. This study aims to identify modifiable factors that are associated with the incidence of acute coronary syndrome (ACS) in young adults in Bali. This quantitative research used a cross-sectional design with a descriptive-analytic study and a consecutive sampling technique on 150 respondents according to the inclusion criteria. Data analysis used descriptive analysis, chi-square test, and logistic regression. The results showed that there was a significant association between Hypertension, Diabetes Mellitus, Dyslipidemia, Hyperurecemia, Diet pattern, Physical activity, Obesity, Smoking, Alcohol consumption, Stress, and Sleep Quality. The most factor associated with the incidence of ACS in young adults in Bali is hypertension (OR=6.785). Recommendations for further research regarding other factors that can affect the incidence of ACS such as cardio-social in young adults in Bali as well as prevention and control strategies based on Balinese culture."

"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: 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"

"Masalah fisik dan emosional masih dialami pasien Sindrom Koroner Akut pascatindakan reperfusi. Ketidakpatuhan dan rasa frustasi dalam menjalankan program prevensi sekunder, berdampak pada tingginya tingkat restenosis dan readmission yang tidak diinginkan. Penelitian ini bertujuan mengidentifikasi efektivitas model asuhan keperawatan mandiri berkelanjutan pada pasien SKA dan pelaku rawat keluarganya terhadap kemampuan perawatan mandiri dan kualitas hidup pasien SKA. Penelitian didesain dalam riset operasional yang terdiri dari 3 tahapan, yaitu tahap studi eksplorasi dengan pendekatan kualitatif, tahap pengembangan model dan tahap uji efektivitas model dengan pendekatan kuantitatif quasy experiment pre-post test with control group pada pasien SKA. Hasil penelitian tahap eksploratif didapatkan tema respons terhadap SKA, faktor risiko dan pendukung perawatan mandiri pasien SKA, dukungan perawatan mandiri pasien SKA, perilaku perawatan mandiri pasien SKA, masalah dukungan upaya perawatan mandiri pasien SKA, kondisi kesehatan pasien SKA pascarawat. Intervensi model efektif meningkatkan kemampuan pelaku rawat keluarga dan kemampuan perawatan mandiri  pasien SKA. Rekomendasi bagi pelayanan keperawatan agar model asuhan keperawatan mandiri berkelanjutan pada pasien SKA dan pelaku rawat keluarganya dapat diimplementasikan sebagai pendekatan asuhan keperawatan pada pasien SKA.

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Physical and emotional problems are experienced by patients with Acute Coronary Syndrome after reperfusion. Non-compliance and frustration in carrying out secondary prevention programs, have an impact on high rates of restenosis and unwanted readmission. This study aims to identify the effectiveness of the continuous independent nursing care model for ACS patients and their family caregivers on the ability of self-care and the quality of life of ACS patients. The research was designed in operational research which consisted of 3 stages, namely the exploratory study phase with a qualitative approach, the model development phase and the model effectiveness test phase with a quasi-experimental quantitative approach pre-post test with control group in ACS patients. The results of the exploratory stage of the study found that the theme of response to ACS, risk factors and support for self-care for ACS patients, support for self-care for ACS patients, self-care behavior of ACS patients, problems with supporting efforts to self-care ACS patients, health conditions of post-treatment ACS patients. The intervention model affects the ability of family caregivers, depression scores, self-care abilities and quality of life of ACS patients. Recommendations for nursing services so that the sustainable independent nursing care model for ACS patients and their family caregivers can be implemented as an approach to nursing care for ACS patients."

"Latar Belakang dan Tujuan: Korelasi antara kadar asam urat dan penyakit kardiovaskular sudah lama diketahui dan terdapat sejumlah penelitian epidemiologi melaporkan korelasi antara kadar asam urat dan berbagai kondisi penyakit kardiovaskular. Kami meneliti korelasi antara kadar asam urat terhadap kompleksitas stenosis arteri koroner pada pasien sindrom koroner akut berdasarkan skor SYNTAX.Metode Penelitian: Penelitian ini adalah studi analisis korelasi dengan desain potong lintang pada total 60 pasien sindrom koroner akut yang menjalani angiografi koroner dari data rekam medik. Penelitian dilakukan di RSCM pada bulan November 2012 dengan sampel data rekam medik ICCU RSCM Januari 2012-Oktober 2012, menggunakan teknik sampling konsekutif. Analisis korelasi pearson digunakan untuk melihat korelasi kadar asam urat dengan kompleksitas stenosis arteri koroner pada pasien sindrom koroner akut, dan analisis multivariat regresi linier.Hasil: Analisis korelasi Pearson pada kadar asam urat terdapat korelasi positif lemah yang bermakna terhadap skor SYNTAX (r=0.3, p=0.02). Kadar asam urat memiliki pengaruh 8 % terhadap kompleksitas stenosis arteri koroner. Analisis multivariat regresi linier menunjukkan asam urat (?; 0.3, p<0.018) merupakan faktor independen terhadap skor SYNTAX.Kesimpulan: Pada penelitian kami, kadar asam urat memiliki korelasi lemah dengan kompleksitas stenosis arteri koroner arteri koroner pada pasien sindrom koroner akut. Penelitian selanjutnya dianjurkan apakah pemberian inhibitor xanthine oxidase dapat mencegah progresifitas penyakit arteri koroner.

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Background and Objectives: Serum uric acid has been associated with increased cardiovascular risk in general population recently in many studies. We hypothesized that serum uric acid would be correlated with severity of coronary artery disease. We therefore investigated the link between serum uric acid level and the extend of coronary artery disease (CAD) assessed by SYNTAX score (SS).

Materials and Methods: Subjects’ data were collected through medical record consecutively. A cross sectional study performed in 60 acute coronary syndrome patients who underwent coronary angiography in ICCU, Cipto Mangunkusumo Hospital, Jakarta, from January 2012 untill October 2012. We analyzed the correlation serum levels of uric acid and angiographic severity of CAD. SS was used for assessing the severity of coronary artery disease.

Result: Serum level of uric acid positively weak correlated with SS (r=0.3, p=0.02). Multivariate regression analysis showed that serum level uric acid (?;0.3, p<0.018) were the independent for SS.

Conclution: Serum level of uric acid is independenly correlated with the severity and complexity of CAD evaluated by SS in patient acute coronary syndrome. "

"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."

"Latar Belakang: Pasien diabetes melitus tipe 2 menunjukkan peningkatan risiko penyakit jantung koroner dengan kondisi aterosklerosis arteri koroner yang lebih berat. Ketebalan lemak epikardial diperkirakan berhubungan dengan kondisi inflamasi dan derajat stenosis arteri koroner pada pasien DM tipe 2 dengan chronic coronary syndrome (CCS), dimana kadar HsCRP dapat digunakan sebagai penanda inflamasi dan skor Gensini digunakan untuk menilai derajat stenosis arteri koroner.Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi antara ketebalan lemak epikardial dengan kadar dan HsCRP derajat stenosis arteri koroner pada pasien DM tipe 2 dengan CCS.Metode: Studi potong lintang pada 47 pasien DM tipe 2 dengan CCS yang berusia antara 35 sampai 87 tahun dan menjalani angiografi koroner di Laboratorium Kateterisasi Jantung PJT-RSCM. Nilai ketebalan lemak epikardial diperoleh dari hasil pemeriksaan ekokardiografi, skor Gensini dihitung berdasarkan hasil pemeriksaan angiografi koroner, dan kadar HsCRP diperiksa menggunakan metode Imunoturbidimetri.Hasil: Diperoleh median kadar HsCRP sebesar 1,9 mg/L (RIK 0,8–3,30 mg/L), rerata ketebalan lemak epikardial sebesar 6,06 ± 2,14 mm, dan median skor Gensini sebesar 34 (RIK 14–84). Didapatkan korelasi positif sedang antara ketebalan lemak epikardial dan HsCRP (p<0,05; r = 0,500, namun tidak menemukan adanya korelasi yang bermakna antara ketebalan lemak epikardial dan skor Gensini (p > 0,05).Kesimpulan: Ketebalan lemak epikardial hanya menunjukkan adanya korelasi yang bermakna dengan kadar HsCRP pada pasien DM tipe 2 dengan CCS, namun tidak dengan derajat stenosis arteri koroner yang dinilai berdasarkan skor Gensini. Jadi dengan memeriksa ketebalan lemak epikardial dengan ekokardiografi kita dapat memperkirakan tingkat inflamasi pada pasien DM tipe 2 dengan CCS

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Background: T2DM patients showed an increased risk of CAD with more severe coronary artery atherosclerosis. Epicardial fat thickness (EFT) was presumed to be associated with inflammatory conditions and the severity of coronary artery stenosis in patients with T2DM and CCS, wherein HsCRP levels can be used as an inflammatory marker and Gensini score to quantify the severity of coronary artery stenosis.

Objective: To determine the correlation between EFT and HsCRP levels and the severity of coronary artery stenosis in patients with T2DM and CCS.

Methods: A cross sectional study conducted among 47 patients with T2DM and CCS between the age of 35 to 87 that had underwent coronary angiography at the Heart Catheterization Laboratory of PJT-RSCM. Results of echocardiography was evaluated to determine EFT, while the Gensini score was calculated based on the results of coronary angiography, and HsCRP levels was evaluated using a commercial Immunoturbidimetry kit.

Results: Median HsCRP levels was 1.9 mg/L (IQR 0.8–3.30 mg/L), mean EFT was 6.06 ± 2.14 mm, and median Gensini score was 34 (IQR 14–84). There was a moderate positive correlation between EFT and HsCRP (p < 0.05, r = 0.500), but found no significant correlation between EFT and Gensini score (p > 0.05).

Conclusion: EFT only showed significant correlation with HsCRP levels in patients with T2DM and CCS, but showed no correlation with the severity of coronary artery stenosis that was quantified by Gensini score. So, by echocardiography evaluation of epicardial fat thickness, we could have an estimation of inflamation degree in patients with T2DM and CCS."

"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."

"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."