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"Latar Belakang: Skor Global Registry of Acute Coronary Events (GRACE) adalahmodel stratifikasi risiko yang secara luas telah digunakan untuk memprediksi luaranpada pasien infark miokard akut (IMA). Pasca IMA dapat terjadi disfungsi miokardbaik sistolik maupun diastolik. Myocardial Performance Index (MPI) merupakanparameter ekokardiografi yang mampu menggambarkan fungsi sistolik dandiastolik ventrikel kiri secara bersamaan dan merupakan prediktor independenkejadian Major Adverse Cardiovascular Event (MACE) pasca IMA.Tujuan: Mengetahui peranan penambahan MPI ke dalam skor GRACE untukmemprediksi MACE selama lima hari perawatan rumah sakit.Metode: Penelitian kohort prospektif pada 75 pasien IMA di ruang perawatanintensif jantung RSCM antara Juli-November 2020. Dilakukan perhitungan totalskor GRACE saat pasien masuk rumah sakit dan pemeriksaan ekokardiografi untukmendapatkan nilai MPI dilaksanakan dalam 72 jam perawatan rumah sakit.Observasi terhadap kejadian MACE selama 5 hari perawatan rumah sakit dilakukanpada seluruh pasien. Peranan penambahan parameter MPI ke dalam skor GRACEdinilai menggunakan perubahan area under curve (AUC) metode DeLong,likelihood ratio test (LRT) dan continous net reclassification improvement (cNRI).Hasil: Kemampuan prediksi skor GRACE baik (AUC 0,753 IK 95% 0,639-0,868).Penambahan MPI ke dalam skor GRACE secara signifikan meningkatkan performamodel kombinasi (AUC 0,801 IK 95% 0,699-0,902 p=0,354, LRT 4,65 p=0,03 dancNRI 0,515 IK 95% 0,008-1,021 p=0,046).Simpulan: Penambahan MPI ke dalam skor GRACE signifikan meningkatkankemampuan skor kombinasi untuk memprediksi MACE selama lima hari perawatanrumah sakit pada pasien IMA.

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Background: The Global Registry of Acute Coronary Events (GRACE) risk score

is widely recommended for risk assessment in patients with acute myocardial

infarction (AMI). Myocardial infarction induces variable degrees of impairment in

left ventricular (LV) systolic and diastolic function. Myocardial Performance Index

(MPI) is an echocardiography parameter that capable of estimating combined

systolic and diastolic LV performance and can independently predict Major

Adverse Cardiovascular Events (MACE) post AMI.

Objective: To investigate whether MPI has incremental predictive value over the

GRACE risk score in predicting MACE during five days of hospitalization after

AMI.

Methods: A prospective cohort study was conducted in 75 patients presented with

AMI in Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital between July

to November 2020. Total GRACE score was calculated on patient admission and

echocardiography was conducted within 72 hours of hospitalization for

measurement of MPI. All patients were observed for the incidence of MACE during

five days of hospitalization. The incremental predictive value of the GRACE risk

score alone and combined with MPI was assessed by the change in area under

curve (AUC) by DeLong’s method, likelihood ratio test (LRT) and continuous net

reclassification improvement (cNRI).

Results: The GRACE risk score demonstrated good discrimination for MACE

(AUC 0.753 95% CI 0.639-0.868). Adding MPI to the GRACE risk score improved

model performance significantly (AUC 0.801 95% CI 0.699-0.902 p=0.354, LRT

4.65 p=0.03 and cNRI 0.515 95% CI 0.008-1.021 p=0.046).

Conclusions: Adding MPI to the GRACE risk score significantly improves risk

prediction of MACE during five days of hospitalization after AMI."

"Latar Belakang: Pasien infark miokard akut (IMA) dengan hipertensi memiliki risiko yang lebih tinggi untuk terjadinya major adverse cardiac events (MACE). Pengukuran left ventricular mass index (LVMI) dengan ekokardiografi dapat membantu mengidentifikasi pasien IMA dengan hipertensi yang memiliki risiko untuk terjadinya MACE. Namun, penelitian mengenai hubungan antara LVMI dengan kejadian MACE pada pasien IMA dengan hipertensi pasca revaskularisasi perkutan belum ada di Indonesia.Tujuan: Mengetahui hubungan antara LVMI dan MACE pada pasien IMA dengan hipertensi pasca revaskularisasi perkutan.Metode: Penelitian ini merupakan studi kohort retrospektif di RSUPN Dr. Cipto Mangunkusumo dengan menggunakan data rekam medis pada periode tahun 2018–2022. Nilai LVMI didapatkan berdasarkan pemeriksaan ekokardiografi. Kejadian MACE dinilai pada saat perawatan Intensive Cardiology Care Unit (ICCU). Analisis menggunakan uji univariat, bivariat (chi-square), dan multivariat (regresi logistik) untuk melihat hubungan antara LVMI dan MACE pada pasien IMA dengan hipertensi pasca revaskularisasi perkutan.Hasil: Dari 160 pasien dengan IMA dan hipertensi yang menjalani revaskularisasi perkutan, terdapat 38 subjek (23,8%) yang mengalami MACE selama perawatan di ICCU. Dari 51,9% subjek dengan nilai LVMI meningkat, terdapat 34,9% yang mengalami MACE. Terdapat hubungan yang bermakna antara LVMI dan MACE dengan RR 2,99 (IK 95% 1,51-5,90) p 0,002). Pada analisis multivariat regresi logisitk, setelah memperhitungkan variabel perancu (usia dan penyakit ginjak kronik), LVMI secara independen terkait dengan peningkatan risiko kejadian MACE, dengan adjusted RR yang disesuaikan sebesar 2,869 (IK 95% 1,443–5,703) p 0,003.Kesimpulan: Terdapat hubungan yang bermakna antara LVMI dan MACE pada pasien IMA dengan hipertensi pasca revaskularisasi perkutan.

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Background: Patients with acute myocardial infarction (AMI) and hypertension have a higher risk of major adverse cardiac events (MACE) complications. Measuring the left ventricular mass index (LVMI) with echocardiography can help to identify AMI patients with hypertension who are at risk for MACE. However, study regarding the association between LVMI and MACE occurrence in patient with AMI and hypertension post-percutaneous coronary intervention (PCI) has not been conducted in Indonesia.

Objective: To determine the association between LVMI and MACE in patients with AMI and hypertension after PCI.

Methods: This is a retrospective cohort study at Dr. Cipto Mangunkusumo National General Hospital utilizing medical record data from the period of 2018 to 2022. The LVMI values were obtained based on echocardiographic examinations. MACE events were assessed during ICCU (Intensive Cardiology Care Unit) admission. The analysis utilized univariate, bivariate (chi-square), and multivariate (logistic regression) tests to examine the association between LVMI and MACE in patients with AMI and hypertension post-PCI.

Results: A total of 160 patients with AMI and hypertension undergoing PCI, 38 subjects (23.8%) experienced MACE during follow up in ICCU. Among 51,9% subjects with increased LVMI, 34.9% experienced MACE. There was a significant association between LVMI and MACE with a relative risk (RR) of 2,99 (95% CI 1,51–5,90, p 0,002). After adjustment for the confounders (age and chronic kidney disease) in a multivariate analysis logistic regression, LVMI was independently associated with risk for MACE with adjusted RR 2,869 (95% CI 1,443–5,703, p 0,003)

Conclusion: There was a significant association between LVMI and MACE in patients with AMI and hypertension who have undergone percutaneous revascularization."

"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)."

"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."

"Latar belakang: Hipertensi akan meningkatkan kadar asam urat yang akan memperburuk terjadinya Major Adverse Cardiac Events (MACE) pada penderita sindroma koroner akut (SKA). Dengan mengetahui kadar asam urat maka kita memprediksi terjadinya MACE sehingga dapat melakukan tata laksana SKA yang lebih optimal. Metode: Penelitian diakukan secara kohort retrospektif dengan menggunakan analisa kesintasan MACE selama tujuh hari pada penderita hipertensi yang mengalami SKA. Data diambil melalui rekam medis ICCU RSCM selama 2009-2013 secara konsekutif. Analisa data menggunakan kurva Kaplan Meir, Cox proportional hazard regression, analisis multivariat Cox proportional hazard regression. Hasil Penelitian: Dua ratus lima puluh subyek penelitian dibagi dalam dua kelompok hiperurisemia dan tanpa hiperurisemia. MACE lebih banyak terjadi pada kelompok hiperurisemia yaitu 38 pasien dari 125 pasien (30.4%) dibandingkan tanpa hiperurisemia sebesar 16 pasien dari 125 pasien (12.8%). Analisa kesintasan mendapatkan MACE lebih cepat dan bermakna pada penderita hiperurisemia (P<0.001). Analisa Cox proportional hazard regression mendapatkan hasil hazard ratio sebesar 1.676 (IK95% 1.243-2.260). Analisa multivariat mendapatkan adjusted hazard ratio tidak berbeda bermakna pada variabel-variabel karakteristik dasar yang inhomogen yaitu variabel gagal jantung, ejeksi fraksi ventrikel kiri dan gangguan fungsi ginjal. Simpulan: Terdapat perbedaan kesintasan terjadinya MACE selama tujuh hari pada hipertensi yang mengalami SKA dengan hiperurisemia dan kelompok tanpa hiperurisemia dengan Hazard Ratio sebesar 1,676.

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Background: Hypertension has strong correlation with uric acid levels. Many studies shows that hyperuricemia make worse major adverse cardiac events (MACE) in acute coronary syndrome patients. This study wants to assess the clinical value of hyperuricemia to make major adverse cardiac events in seven days in hypertension patients with acute coronary syndrome

Methods: This is a retrospective cohort study by using medical record in intensive care coronary unit RSCM hospital. We evaluated two hundred fifty consecutive inpatients who were hospitalized by acute coronary syndrome with hypertension from 2009 to 2014. Data were analized with Kaplan Meir curved, Cox proportional hazard regression, Cox proportional hazard regression multivariate analysis.

Results: Incidence of MACE in hyperuremic patients were 38 from 125 patients (30.4%) and no hyperuricemic patients were 16 from 125 patients (12.8%). Hyperuricemia was associated higher incidence of MACE with hazard ratio 1.676 (CI 1.254-2.260). After adjustment comorbid factors which are inhomogeneity in baseline characteristics for acute heart failure, kidney dysfunction and left ventricular ejection fraction, hazard ratio were not different with Crude hazard ratio.

Conclusions: Hyperuricemia was associated higher incidence of Major Adverse Cardiac Events with hazard ratio 1.676 in survival analysis in seven days in hypertension patients with Acute Coronary Syndrome."

"Latar Belakang. Salah satu penyebab kematian pada sindrom koroner akut adalah terjadinya komplikasi yang dikenal dengan major adverse cardiac event MACE . Terdapat beberapa prediktor terjadinya MACE pada pasien SKA, diantaranya adalah faktor psikologis yaitu depresi dan ansietas. Saat ini, depresi dan ansietas belum mendapat banyak perhatian padahal memiliki peran penting dalam pengobatan SKA dan prognosisnya. Tujuan. Mengetahui hubungan antara depresi dan ansietas dengan major adverse cardiac event dalam 7 hari pada pasien SKA. Metode. Studi dengan desain kohort prospektif untuk meneliti hubungan antara depresi dan ansietas dengan MACE dalam 7 hari pasien SKA, dengan menggunakan kuisioner HADS pada pasien SKA yang menjalani perawatan di ICCU, Rawat Inap Gedung A RSCM pada bulan Januari ndash; Mei 2018. Analisis bivariat dilakukan untuk menghitung risk ratio RR terjadinya MACE dalam 7 hari pada kelompok depresi dan ansietas dengan menggunakan SPSS. Hasil. Didapatkan jumlah subjek yang memenuhi kriteria inklusi sebanyak 114 orang. depresi didapatkan pada 7 subjek, ansietas didapatkan pada 28,95 subjek, dan MACE didapatkan pada 9,6 subjek. Pada kelompok depesi, MACE 7 hari terjadi pada 12,5 subjek. Pada kelompok Ansietas, MACE 7 hari terjadi pada 21,2 subjek. Pada analisis bivariat didapatkan ansietas meningkatkan risiko terjadinya MACE dalam 7 hari pada pasien SKA, dengan risiko relatif RR sebesar 4,2 IK 1,34 ndash; 13,7. Kesimpulan. Proporsi depresi pada pasien SKA di RSCM sebesar 7 dan proporsi ansietas pada pasien SKA di RSCM sebesar 28,95 . Ansietas pada pasien SKA merupakan prediktor independen terjadinya MACE dalam 7 hari dan meningkatkan risiko terjadinya MACE 7 hari.

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Background. One of the causes of death in acute coronary syndrome is the occurrence of a complication known as major adverse cardiac event MACE. There are several predictors of the occurrence of MACE in patients with ACS, including psychological factors such as depression and anxiety. Currently, depression and anxiety have not received much attention when it has an important role in the treatment of ACS and its prognosis.

Objective. To determine the association between depression and anxiety with major adverse cardiac event within 7 days in patients with acute coronary syndrome.

Method. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in January May 2018. Bivariate analysis was performed to calculate the risk ratio RR of MACE occurrence within 7 days in the depression and anxiety group using SPSS.

Results. Obtained number of subjects who meet the inclusion criteria of 114 people. depression was obtained in 7 of subjects, Anxiety was obtained in 28,95 of subjects, and MACE was obtained in 9.6 of subjects. In the depression group, MACE 7 days occurred in 12.5 of subjects. In the Anxiety group, MACE 7 days occurred in 21,2 of subjects. In bivariate analysis, anxiety increased the risk of MACE within 7 days in patients with ACS, with relative risk RR of 4,2 IK 1,34 ndash 13,7.

Conclusion. The proportion of depression in patients with SKA in RSCM was 7 and the proportion of anxiety in ACS patients in RSCM was 28,95. Anxiety in patients with ACS is an independent predictor of MACE within 7 days and increases the risk of a 7 day MACE. "

"Latar Belakang: Infark miokard salah satu penyebab kematian terbanyak di dunia. MACE (Major Adverse Cardiac Event) adalah komplikasi akut utama yang terjadi pada pasien infark miokard, meliputi gagal jantung akut, syok kardiogenik dan aritmia fatal. Diperlukan biomarker yang akurat, mudah dilakukan dan cost-effective untuk memprediksi MACE dan kematian. Cedera hati hipoksik atau HLI (hypoxic liver injury) adalah salah satu biomarker potensial menggunakan kadar enzim hati transaminase (aspartate transaminase) sebagai parameter. Penelitian ini bertujuan mengetahui peran HLI sebagai prediktor MACE pada pasien infark miokard tanpa gambaran EKG elevasi segmen ST (NSTEMI).Metode: Penelitian ini merupakan penelitian potong lintang dengan keluaran berupa MACE dan kohort retrospektif dengan keluaran kematian selama masa perawatan. Populasi penelitian adalah semua pasien NSTEMI yang menjalani perawatan di ICCU RSCM. Sampel penelitian adalah pasien NSTEMI yang menjalani perawatan di ICCU RSCM pada tahun 2006-2016 dan memenuhi kriteria penelitian sebanyak 277 subyek. Penentuan titik potong HLI berdasarkan kadar aspartate transaminase (AST) yang dapat memprediksi MACE dan kematian dihitung dengan kurva ROC. Analisis multivariat dilakukan menggunakan regresi logistik untuk mendapatkan POR terhadap MACE dengan memasukkan kovariat. Analisis bivariat mengenai sintasan pasien terhadap kematian dilakukan dengan menggunakan kurva Kaplan-Meier dan diuji dengan Log-rank.Hasil: MACE pada penelitian ini adalah 51,3% (gagal jantung akut 48,4%, aritmia fatal 6,5%, syok kardiogenik 7,2%) dan angka kematian sebesar 6,13%. Median nilai AST adalah 35 U/L pada seluruh subyek, 40 (8-2062) U/L pada subyek dengan MACE dan 31 (6-1642) U/L dengan subyek tanpa MACE (p 0,003). Nilai titik potong yang diambil untuk memprediksi MACE adalah 101,0 U/L (sensitivitas 21,8%, spesifisitas 89,6%, POR 2,727 (IK 95% 1,306-5,696), p 0,006). Pada analisis multivariat tidak didapatkan hubungan yang bermakna antara HLI dengan MACE. Nilai titik potong untuk memprediksi kesintasan terhadap kematian adalah 99,0 U/L (sensitivitas 23,5%, spesifisitas 83,8%, likelihood ratio + 1,46). Tidak didapatkan perbedaan kesintasan yang bermakna antara subyek dengan nilai HLI di bawah dan di atas titik potong kadar AST.Kesimpulan: Terdapat perbedaan median nilai AST yang bermakna pada pasien NSTEMI dengan dan tanpa MACE. Titik potong kadar AST untuk memprediksi MACE adalah 101,0 U/L. Titik potong kadar AST untuk memprediksi kesintasan adalah 99 mg/dl. Tidak terdapat perbedaan kesintasan pada pasien dengan nilai HLI di bawah dan di atas titik potong kadar AST.

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Background: Myocard infarction (MI) is the leading cause of death around the world. Major Adverse Cardiac Events (MACE) complicating MI are acute heart failure, cardiogenic shock and fatal arrhytmia. An accurate, easy and cost-effective biomarker is needed to predict MACE and mortality in patients with MI. Hypoxic liver injury (HLI) is a potential biomarker using aspartate transaminase (AST) level as the parameter. This study is aimed to discover HLI's role in predicting MACE in Non ST Elevation Myocard Infarct (NSTEMI).Method: This study is designed as cross sectional to predict MACE and prospective cohort for survival analysis. Study population is all NSTEMI patients admitted to ICCU of Cipto Mangunkusumo Hospital and study sample are NSTEMI patients admitted to ICCU of Cipto Mangunkusumo Hospital that meets all criteria during 2006-2016 (277 subjects). Cut-off level of AST for HLI to predict MACE and mortality is analyzed using ROC curve and AUC. Survival analysis is done using Kaplan Meier curve and the difference is tested with Log-Rank.Result: Incidence of MACE in this study is 51.3% (acute heart failure 48.4%, fatal arrhytmia 6.5%, cardiogenic shock 7.2%) and mortality rate is 6.13%. The median of AST level on all subject is 35 U/L, 40 (8-2062) U/L in subjects with MACE and 31 (6-1642) U/L in subjects without MACE (p 0.003). Cut-off level for AST used to predict MACE is 101 U/L (sensitivity 21.8%, specificity 89.6%, POR 2.727 (CI 95% 1.306-5.696), p 0.006). In multivariate analysis, HLI is insignificantly related to MACE. Cut-off level for AST used to predict survival is 99 U/L (sensitivity 23.5%, specificity 83.8%, likelihood ratio + 1.46). There are no significant difference of survival between groups with HLI level below and above the cut-off AST level.Conclusion: There is significant differences of median AST level between NSTEMI patients with and without MACE. Cut-off level for AST used to predict MACE is 101 U/L. Cut-off level for AST used to predict survival is 99 U/L. There are no significant difference of survival between groups with AST level below and above the cut-off AST level."

"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."

"[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. Infark miokard akut (IMA) masih merupakan salah satu penyebab kematian tertinggi di Indonesia dan dunia. Kejadian perdarahan pada pasien IMA berkaitan dengan angka mortalitas yang jauh lebih tinggi. Kejadian perdarahan ditemukan lebih tinggi pada populasi IMA dengan elevasi segmen ST (IMA-EST) dibandingkan dengan IMA non elevasi segmen ST (IMA-NEST). Analisa register skala besar telah mengidentifikasi faktor-faktor yang berhubungan dengan kejadian perdarahan, dan beberapa diantaranya diaplikasikan sebagai sistem skor. Namun hingga saat tulisan ini dibuat, belum ada satupun sistem skor yang dibuat khusus untuk populasi IMA-EST. Metode. Studi retrospektif kohort dilakukan di Pusat Jantung Nasional Harapan Kita, Jakarta pada pasien IMA-EST yang menjalani intervensi koroner perkutan primer (IKPP). Kejadian perdarahan positif menggunakan definisi Bleeding Academic Research Consortium (BARC). Karakteristik dasar, pemeriksaan klinis awal, data laboratorium, roentgen, terapi awal, tindakan IKPP, dan terapi selama perawatan merupakan kategori dari variabel yang dikumpulkan melalui rekam medis dan sistem informasi rumah sakit. Data kemudian diolah dengan analisis multivariat menggunakan metode logistik regresi dan diberikan pembobotan sehingga menjadi suatu sistem skor. Sistem skor ini kemudian diuji kembali dengan menggunakan populasi yang sama. Hasil. Sebanyak 579 sampel berhasil dikumpulkan, dengan 42 diantaranya mengalami perdarahan (7.3%). Variabel yang masuk ke dalam model akhir adalah jenis kelamin perempuan, kelas Killip 3 / 4, Umur ≥ 62 tahun, Leukosit >12.000, Kreatinin >1.5, IMT ≥ 25, Lesi koroner multipel, Akses femoral, dan Pemasangan TPM. Uji diskriminasi dan kalibrasi dari model akhir menunjukkan hasil yang baik. Model alternatif dibuat dengan menghilangkan variabel yang berkaitan dengan hasil dan prosedur tindakan intervensif. Kesimpulan. Sistem skor baru ini merupakan suatu sistem untuk memprediksi kejadian perdarahan pada populasi IMA-EST yang menjalani IKPP. Skor ini memiliki nilai kalibrasi dan diskriminasi yang baik sehingga diharapkan dapat membantu menentukan strategi tatalaksana selama perawatan.

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Background. Acute myocardial infarction still become one of the leading mortality cause in the world. Among these patients, ST elevation myocardial infartion (STEMI) has the greatest mortality rate among other type of Myocardial Infarction. When a myocard infarct patient have bleeding events, mortality rate greatly increased. Up until now, there is no specific bleeding risk assessment tool to predict bleeding events in STEMI patient.

Methods. A retrospective cohort study, done in National Cardiovascular Center Harapan Kita, Jakarta in STEMI patients underwent Primary Percutaneous Coronary Intervention (PPCI). Bleeding event was defined according to definition by Bleeding Academic Research Consortium (BARC). Categories for data obtained was basic characteristics, clinical examinations, initial therapies, lab results, x-ray, PPCI procedures, and in hospital treatments. Statistical analysis was done using multivariat analysis using logistic regression method and then converted to a scoring system.

Result. 579 sampels fit the inclusion and exclusion criteria. Bleeding event occured in 42 patients (7.3%). Score was created by assignment of variables that included in the final model according to their Odds Ratio (OR) values. The variables are female gender, Killip class 3 / 4, Age ≥ 62 y.o, White blood cell >12.000, Creatinine >1.5, Body Mass Index ≥ 25, Multiple coronary lesion, Femoral access, and TPM implantation. These variabels was converted into two type of scoring system. The complete model contains all of the variables, and the alternative model discard variables related to interventional result and procedures.

Conclusion. A new scoring system quantifies risk for in-hospital bleeding event in STEMI patients underwent PPCI, which enhances baseline risk assessment for STEMI care."