Hasil Pencarian  ::  Simpan CSV :: Kembali

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

---

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

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

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

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

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

"Latar belakang: Pasien gagal jantung dengan penurunan fraksi ejeksi memiliki angka readmisi yang lebih tinggi dibandingkan dengan fraksi ejeksi normal, dan angka readmisi paling tinggi pada 30-hari pertama pascakeluar admisi sebelumnya. Sekitar 30% pasien dengan gagal jantung juga mengalami Diabetes Melitus (DM) Tipe-2. Sejauh ini, belum ada prediktor kejadian readmisi dalam 30-hari pada pasien dengan populasi tersebut di RSJPDHK, khususnya prediktor dari sisi klinis dan metabolik.Tujuan: Mengetahui prediktor klinis dan metabolik terhadap kejadian readmisi dalam 30-hari pada pasien Gagal Jantung Dekompensasi Akut (GJDA) dengan penurunan fraksi ejeksi dan DM tipe-2.Metode: Studi dilakukan secara kohort retrospektif, data diambil dari rekam medis berdasarkan admisi pasien yang memenuhi kriteria inklusi antara Januari 2016-Januari 2021. Luaran klinis terbagi menjadi kelompok readmisi dan kelompok non-readmisi. Luaran klinis yang dinilai adalah kejadian readmisi akibat perburukan kondisi gagal jantung pada 30-hari pascaadmisi terakhir di RSJPDHK. Dilakukan analisis multivariat untuk menentukan prediktor yang bermakna menentukan readmisi dalam 30-hariHasil: Dari total 747 subjek penelitian, 179 subjek termasuk ke dalam kelompok readmisi, dan 568 subjek termasuk ke dalam kelompok non-readmisi (angka readmisi 24%). Analisis regresi logistik multivariat menunjukkan bahwa faktor-faktor yang berhubungan dengan kejadian readmisi dalam 30-hari adalah: irama fibrilasi atrium (OR 2.616; 95% IK: 1.604-4.267; p 0.000), serta denyut jantung saat pulang rawat (OR 1.022; 95% IK: 1.005-1.039; p 0.010). Kadar gula darah post-prandial < 140 mg/dL menjadi prediktor protektif untuk kejadian readmisi dalam 30-hari (OR 0.528; 95% IK: 0.348-0.802; p 0.003).Kesimpulan: Dua faktor klinis yaitu irama fibrilasi atrium dan denyut jantung saat akhir masa rawat menjadi prediktor readmisi yang bermakna terhadap kejadian readmisi dalam 30-hari akibat perburukan kondisi gagal jantung, sedangkan kadar gula darah post-prandial < 140 mg/dL menjadi faktor protektif untuk kejadian readmisi 30-hari pada populasi pasien gagal jantung dengan penurunan fraksi ejeksi dan DM tipe-2.

---

Background: Patients Heart Failure with reduced Ejection Fraction (HFrEF) had higher readmission rates than normal ejection fractions, and readmission rates were highest in the first 30-days post-admission. About 30% of patients with heart failure also have Type-2 Diabetes Mellitus (DM). So far, there is no predictors for the incidence of 30-days readmission in patients with this kind of population in National Cardiovascular Centre Harapan Kita (NCCHK).

Objective: To determine the clinical and metabolic predictors of 30-days readmission in patients with Acute Decompensated Heart Failure (ADHF) with reduced ejection fraction and type-2 DM.

Methods: The study was conducted in a retrospective-cohort, data were taken from medical records based on admissions of patients who met the inclusion criteria between January 2016-January 2021. The clinical outcomes were divided into readmission and non-readmission groups. The clinical outcome assessed was the incidence of readmission due to worsening of the condition of heart failure at 30-days after the last admission at NCCHK. Multivariate analysis was performed to determine significant predictors for 30-day readmission.

Result: Of the total 747 research subjects, 179 subjects were included in the readmission group, and 568 subjects included in the non-readmission group (readmission rate 24%). Multivariate logistic regression analysis showed that the factors associated at 30-days readmission were: atrial fibrillation rhythm (OR 2.616; 95% CI: 1.604-4,267; p 0.000), heart rate at discharge (OR 1.022; 95% CI: 1.005-1.039; p 0.010). Post-prandial blood glucose level < 140 mg/dL was a protective predictor for 30-day readmission (OR 0.528; 95% CI: 0.348-0.802; p 0.003).

Conclusions: Two clinical factors, namely atrial fibrillation and heart rate at the end of hospitalization, were significant predictors of readmission in 30 days due to worsening of heart failure, while postprandial blood sugar levels < 140 mg/dL were protective factors for 30-days readmission in population of heart failure with reduced ejection fraction and type-2 DM."

"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.

---

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."

"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, kemampuan perawatan mandiri dan kualitas hidup 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.

---

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: Pasien sindom koroner akut (SKA) dengan gejala ansietas berisiko mengalami luaran negatif yang dimediasi oleh disfungsi otonom yang dapat dinilai dengan variabilitas denyut jantung (VDJ). Penurunan VDJ ditemukan baik pada pasien SKA maupun ansietas. Penelitian ini bertujuan untuk mengetahui perbedaan nilai VDJ pada pasien SKA dengan gejala ansietas dibandingkan dengan tanpa gejala ansietas dan menentukan korelasi antara nilai VDJ dengan gejala ansietas. Metode: Penelitian ini merupakan studi potong lintang. Subjek penelitian diambil dari data penelitian utama pada pasien SKA yang dirawat di ruang intensif rawat jantung RSCM periode April-September 2021 secara total sampling. Gejala ansietas dinilai dengan kuesioner. Hospital Anxiety and Depression Scale (HADS). Data VDJ yang diambil adalah domain waktu (SDNN, RSSMD) dan frekuensi (LF, HF, rasio LF/HF). Uji Mann-Whitney dilakukan untuk perbedaan nilai VDJ antara subjek dengan gejala ansietas dibanding tanpa gejala ansietas, uji Spearman untuk korelasi antara nilai VDJ dengan gejala ansietas, dan analisis multivariat untuk faktor perancu. Hasil: Tujuh puluh subjek SKA yang dilibatkan terdiri dari 23 subjek dengan gejala ansietas dan 47 subjek tanpa gejala ansietas. Tidak didapatkan perbedaan nilai VDJ (SDNN, RMSSD, LF, HF, rasio LF/HF) antara subjek dengan gejala ansietas dibanding tanpa gejala ansietas secara statistik. Setelah mengontrol variabel perancu, gejala ansietas memiliki korelasi dengan SDNN (r = -0,563; p<0,001) yang dipengaruhi oleh usia (p<0,004); sementara nilai LF (r = -0,63; p< 0,001) dipengaruhi oleh usia (p = 0,007) dan penyekat beta (p = 0,030). Kesimpulan: Tidak didapatkan perbedaan nilai VDJ antara pasien SKA dengan gejala ansietas dibanding tanpa gejala ansietas yang bermakna secara statistik, namun terdapat penurunan nilai SDNN, HF, dan rasio LF/HF pada kelompok dengan gejala ansietas yang lebih besar. Terdapat korelasi antara nilai VDJ (SDNN dan LF) dengan gejala ansietas pada pasien SKA.

---

Background: Acute coronary syndrome (ACS) patients with anxiety symptoms are at high risk of developing poor outcomes mediated by autonomic dysfunction that can be assessed with heart rate variability (HRV). Reductions in HRV are reported not only in ACS but also in anxiety. This study aims to compare HRV of ACS subjects with and without anxiety and to determine the correlation between HRV and anxiety symptoms.

Methods: This research is a cross-sectional study. The study subjects were taken from the primary research data of ACS patients treated at the ICCU of RSCM from April to September 2021 by total sampling. Anxiety symptoms are assessed with Hospital Anxiety and Depression Scale (HADS) questionnaire. HRV analysis consist of time (SDNN, RSSMD) and frequency (LF, HF, LF/HF ratio) domain. Data were analyzed using Mann- Whitney test for differences in HRV between ACS subjects with anxiety symptoms compared to those without anxiety symptoms, Spearman's test for the correlation between HRV and anxiety symptoms, and multivariate analysis for confounding factors.

Results: Seventy ACS subjects involved consisted of 23 subject with anxiety symptoms and 47 without anxiety symptoms. There was no statistical difference in comparison of HRV (SDNN, RMSSD, LF, HF, LF/HF ratio) between anxiety symptoms compare to those without anxiety symptoms. After controlling for confounding variables, SDNN has a correlation with anxiety symptoms (r = -0,563; p<0,001) which was influenced by age (p<0,004); while the LF has a correlation (r = -0,63; p< 0,001) which are influenced by age (p = 0,007) and beta blockers (p = 0,030).

Conclusion: There was no significant difference in HRV values (SDNN, RMSSD, LF, HF, ratio LF/HF) between ACS patients with anxiety symptoms compared to those without anxiety symptoms. There was a correlation between HRV (SDNN and LF) and anxiety symptoms. "

"ABSTRAKLatar belakang: Sindrom Koroner Akut (SKA) merupakan manifestasi penyakit jantung koroner yang dapat menyebabkan kematian mendadak. SKA kebanyakan terjadi pada usia di atas 45 tahun, Namun beberapa tahun terakhir ini angka kejadian infark miokard usia muda meningkat.Tujuan: Mengetahui perbedaan karakteristik angiografi koroner pada pasien SKA usia ≤45 tahun dengan pasien SKA usia > 45 tahun.Metode: Beratnya stenosis pembuluh darah diukur dengan Vessel Score (jumlah pembuluh darah koroner yang sakit dengan stenosis ≥ 70%) dan Stenosis Score.Hasil: Diteliti sebanyak 322 pasien SKA yang telah menjalani angiografi koroner di ICCU RSUPN Cipto Mangunkusumo Jakarta mulai Januari 2008 sampai Desember 2012. Pasien dibagi kedalam dua kelompok. Kelompok satu adalah pasien usia ≤45 tahun dan kelompok kedua pasien usia>45 tahun. Ditemukan 322 pasien SKA (72 kasus ≤45 tahun dan 250 kasus >45tahun). Distribusi jumlah pembuluh darah yang sakit (vessel score) 1 VD (single vessel diseases) terbanyak pada usia ≤ 45 tahun (43.1 % vs 26.0 % ), sedangkan 3 VD (triple vessel diseases) terbanyak pada usia > 45 tahun (31.6 % vs 18,1 %). Hasil skor stenosis menunjukkan lebih rendah pada usia ≤ 45 tahun dibandingkan usia  45 tahun (median skor stenosis 4 vs 8) dengan perbedaan yang bermakna (p<0,001). Pembuluh darah yang mengalami aterosklerosis yang terbanyak adalah Left Anterior Descending baik kelompok usia ≤ 45 tahun dan usia  45 tahun (65.3% and 74.0%). Pembuluh darah Left Circumflex dan Right Coronary Artery lebih sedikit pada usia ≤ 45 tahun dan bermakna secara statistik (26,4% dan 31,9% vs 46,4% dan 57,2%, p=0,002 dan 0,001).Simpulan: Jumlah pembuluh darah koroner yang sakit (vessel score) dan skor stenosis lebih kecil pada usia ≤ 45 tahun dibanding usia > 45 tahun

---

ABSTRACTBackground: Acute Coronary Syndrome (ACS) is the manifestation of coronary heart disease which can cause sudden death. ACS mostly occurs at the age > 45 years, but recently the incidence of myocardial infarction increases in yong ages.Objective: To determine compared between coronary angiography of acute coronary syndrome patients age ≤ 45 years with acute coronary syndrome patients age > 45 years.Methods: The severety of coronary stenosis was determined by Vessel score and Coronary score. Significant vessel score was defined as stenosis of angiography of more or equal to 70% lumen stenosis by eyeball examinationResults :A total of 322 ACS patients who undergone coronary angiography in ICCU Cipto Mangunkusumo from January 2008 to December 2012. Patients were divided into two groups. One patient group is less or equal to the age of 45 years (72 cases) and the second group of patients over the age of 45 years (250 cases).Distribution of number of blood vessels disease 1 VD (single vessel diseases) highest in the age group ≤ 45 years (43.1 % vs 26.0 % ), while 3 VD (triple vessel diseases) highest in the age group > 45 years (31.6 % vs 18,1 %). stenosis score was lower at age ≤ 45 years to compare age > 45 years (median stenosis score 4 vs 8) with statistical significant difference (p < 0.001 ). The Left Anterior Descending Artery significant lesion was found high at the both age groups (65.3% and 74.0%). But the significant stenosis lesion was less found in Left Circumflex and Right Coronary Artery at the age ≤ 45 years (26,4% and 31,9% vs 46,4% and 57,2%, p=0,002 and 0,001).Conclusion :The number of coronary arteries diseases (Vessel score) and Stenosis score is lower at the age ≤ 45 years compared to patients age > 45 years."

"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."

"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.

---

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."

"Sindrom koroner akut (SKA) berkaitan erat dengan aspek nutrisi. Pencegahan primer dan sekunder dimulai saat diketahui pasien memiliki risiko atau telah mengalami gejala. Permasalahan nutrisi pada SKA dapat menurunkan asupan selama perawatan intensif, terutama pada pasien usia lanjut karena terdapat berbagai komorbid yang dapat menjadi kendala pemberian nutrisi. Risiko malnutrisi selama perawatan di rumah sakit juga dapat terjadi dan akan mempengaruhi luaran klinis. Terapi medik gizi bertujuan mengurangi respons inflamasi, mempertahankan imbang energi dan nitrogen positif, mencegah katabolisme, serta mencegah komplikasi. Serial kasus ini melaporkan empat orang pasien SKA yang dirawat di ruang rawat intensif. Usia pasien antara 51–64 tahun. Status gizi pasien saat admisi berkisar dari berat badan normal hingga obes morbid. Terapi medik gizi yang diberikan menggunakan panduan pada perawatan jantung intensif, sakit kritis, dan panduan lain sesuai kondisi klinis pasien. Pemberian nutrisi ditingkatkan bertahap sesuai kondisi klinis dan toleransi saluran cerna dengan target kebutuhan energi total dan protein tercapai saat persiapan pulang rawat. Mikronutrien yang diberikan adalah vitamin B kompleks dan asam folat. Seluruh pasien pulang dengan perbaikan kondisi klinis. Terapi medik gizi yang adekuat mendukung kesembuhan pasien.

---

Acute Coronary Syndrome (ACS) is closely related to nutritional aspects. Primary and secondary prevention should be started when the patients are known to be at risk or have experienced the symptoms. Patients with ACS have nutritional problems that can reduce intake during intensive care, particularly in elderly patients, because of various comorbidities that can be nutritional challenges. The risk of malnutrition during hospitalized may also occur and will affect clinical outcomes. Medical therapy in nutrition aims to reduce the inflammatory response, maintain energy and positive nitrogen balance, and prevent catabolism and complications. The patients were 51–64 years old. The nutritional status of patients at admission ranges from normal weight to morbid obesity. Medical therapy in nutrition was given using the guidelines for cardiac intensive care, critical illness, and other guidelines according to the patient's clinical condition. Provision of nutrition was gradually increased according to the clinical and gastrointestinal tolerance with the goal of achieving total energy requirements during discharge planning. The micronutrients given were B-complex vitamins and folic acid. All patients discharged with improvements in clinical conditions. Adequate medical therapy in nutrition supports the patients recovery."