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"Latar belakang: Populasi usia lanjut dengan penyakit jantung koroner yang menjalani tindakan intervensi koroner perkutan (IKP) menunjukkan tren meningkat. Di sisi lain, kelompok usia lanjut juga dihadapkan dengan major adverse cardiac events pasca tindakan IKP. Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE 30 hari diharapkan dapat menjadi sarana stratifikasi risiko pratindakan, meningkatkan luaran klinis serta menjadi pertimbangan pemilihan strategi intervensi pada pasien PJK usia lanjut.Tujuan: Mengetahui insidens MACE 30 hari, faktor prediktor MACE 30 hari pada pasien PJK usia lanjut yang menjalani tindakan IKP, dan pengembangan model prediksi MACE 30 hari.Metode: studi kohort retrospektif dengan menulusuri rekam medis pasien usia lanjut yang menjalani IKP di RSCM periode Januari 2017-Desember 2021. Dilakukan analisis bivariat chi-square antara faktor usia, jenis kelamin, hiperglikemia saat admisi, kreatinin serum, kelas Killip, status fungsional, status nutrisi, status frailty, dan jenis PJK dengan kejadian MACE 30 hari pascatindakan IKP. Analisis multivariat dan model prediksi dilakukan dengan metode regresi logistik.Hasil: Terdapat 616 subjek penelitian untuk diteliti. Insidens MACE 30 hari pada pasien PJK usia lanjut sebesar 5,4%. Hasil analisis bivariat menunjukkan adanya hubungan antara faktor hiperglikemia saat admisi, kelas Killip, status fungsional, status nutrisi, dan jenis PJK dengan kejadian MACE 30 hari (p<0,05). Hasil regresi logistik menunjukkan Kelas Killip dan jenis PJK merupakan faktor prediktor independen terjadinya MACE 30 hari dengan adjusted OR 8,841 (IK95% 3,339-23,410) untuk kelas Killip dan adjusted OR 3,774 (1,365-10,426) untuk PJK. Model prediksi MACE 30 hari memiliki nilai AUC 0,7995 (IK95% 0,712-0,886)Kesimpulan: MACE 30 hari pada pasien PJK usia lanjut yang menjalani IKP sebesar 5,4% dengan faktor prediktor independen kelas Killip dan jenis PJK.

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Background: The elderly with coronary heart disease undergoing percutaneous coronary intervention (PCI) shows an increasing trend. On the other hand, the elderly group is also faced with major adverse cardiac events after PCI. Identification of predictors that influence the occurrence of 30-day MACE is expected to be a means of preprocedural risk stratification, improve clinical outcomes and become a consideration for selecting intervention strategies in elderly CHD patients.

Objectives: To determine the incidence of 30-day MACE, the predictors of 30-day MACE in elderly CHD patients undergoing PCI, and the development of 30-day MACE prediction model.

Methods: Retrospective cohort study by reviewing medical records of elderly patients undergoing PCI at RSCM for the period January 2017-December 2021. Chi-square bivariate analysis was performed between predictors of age, sex, hyperglycemia at admission, serum creatinine, Killip class, functional status, nutritional status, frailty status, and type of CHD with MACE events 30 days after PCI. Multivariate analysis and prediction models were performed using the logistic regression.

Results: There were 616 research subjects to be studied. The incidence of 30-day MACE in elderly CHD patients was 5.4%. The results of bivariate analysis showed a relationship between hyperglycemia at admission, Killip class, functional status, nutritional status, and type of CHD with 30-day MACE (p<0.05). Logistic regression results showed Killip class and CHD type were independent predictors of 30-day MACE with adjusted OR 8.841 (95%CI 3.339-23.410) for Killip class and adjusted OR 3,774 (1.365-10.426) for type of CHD. The 30-day MACE prediction model has an AUC value of 0.7995 (95%CI 0.712-0.886)

Conclusion: Incidence of 30-day MACE in elderly with CHD undergoing PCI is 5.4% with Killip class and type of CHD as independent predictor factors."

"Latar Belakang: Angka harapan hidup yang meningkat menyebabkan peningkatan populasi usia lanjut termasuk populasi usia lanjut dengan penyakit jantung koroner. Frailty sering ditemukan pada pasien usia lanjut dengan penyakit kardiovaskular dan keberadaan frailty sangat mempengaruhi prognosis penyakit jantung koroner pada pasien usia lanjut termasuk luaran terhadap intervensi revaskularisasi. Percutaneous Coronary Intervention (PCI) adalah salah satu metode revaskularisasi dan belum banyak penelitian yang dilakukan terkait pengaruh frailty terhadap luaran pasien usia lanjut yang menjalani PCI elektif. Tujuan: Penelitian ini dilakukan untuk mendapatkan proporsi frailty, insidensi Major Adverse Cardiovascular Events (MACE) 30 hari dan mengkaji peran frailty terhadap prognosis pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif. Metode: Secara prospektif dilakukan penilaian terhadap kondisi frailty pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif di RS Cipto Mangunkusumo dengan menggunakan kriteria Frailty Phenotipe. Pasien kemudian di follow-up selama 30 hari setelah tindakan PCI elektif untuk melihat apakah MACE terjadi atau tidak. Hasil: Terdapat 100 pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif dari bulan September 2014 - Juni 2015. Usia rata-rata pasien adalah 66.95 tahun (SD = 4.875) dengan pasien terbanyak adalah laki-laki (69%). Sebanyak 61% pasien termasuk ke dalam kelompok frail. MACE terjadi pada 8.19% pasien pada kelompok frail dan 5.12% pada kelompok non-frail. Hubungan frailty terhadap MACE dapat dilihat dari hasil crude Hazard Ratio (HR) 1.6 (IK 95% 0.31-8.24). Pada penelitian ini, kesintasan 30 hari 95% pada kelompok frail, sementara pada kelompok non-frail kesintasan 30 hari adalah sebesar 98%. Kesimpulan: Terdapat peningkatan risiko 1.6 kali untuk terjadinya MACE 30 hari pada subyek usia lanjut frail yang menjalani PCI elektif namun belum bermakna secara statistik.

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Background: The increase in life expectancy caused the increase in elderly population including the population of elderly with Coronary Artery Disease. Frailty is commonly found in elderly patients with cardiovascular disease and frailty had a major influence in determining the prognosis of cardiovascular disease in elderly including the outcome of revascularization intervention. PCI (Percutaneous Coronary Intervention) is one method of revascularization. However, frailty research on the effect on the outcome of elderly patients with coronary artery disease undergoing PCI is still limited.

Aim: To get the proportion of frailty and 30 days Major Adverse Cardiovascular Events (MACE) incidence, and to review impact of frailty in elderly patients with coronary heart disease who underwent elective PCI.

Method: The frailty condition of the elderly patients with coronary artery disease that underwent elective PCI in Cipto Mangunkusumo Hospital was assessed with the Frailty Phenotype criteria. After the patients underwent the elective PCI, they were followed for 30 days to see whether MACE occurred or not.

Result: There are 100 elderly patients with coronary artery disease that underwent elective PCI from September, 2014 until June, 2015. The mean age of patients is 66.95 ± 4.875 years and 69% of the patients were males. Frail was present in 61% of the patients. MACE were occurred in 8.19% of frail patients and 5.12% were occurred in non-frail patients. The correlation between frailty and MACE could be seen in the result of crude HR 1.6 (CI 95% 0.31-8.24). In this research, the 30 days survival rate is 95% in frail patients and 98% in non-frail patients.

Conclusion: There is a 1.6 fold increased risk of 30 days MACE in elderly frail patients that underwent elective PCI but it is not statistically significant."

"Latar belakang : Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya mortalitas pada pasien ST-Elevasi Miokard Infark (STEMI) yang menjalani intervensi koroner perkutan primer (IKPP). Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE selama perawatan diharapkan dapat meningkatkan perawatan dan luaran klinis dari pasien STEMI. Penelitian ini bertujuan untuk mengetahui faktor prediktor MACE selama perawatan pada pasien STEMI yang dilakukan IKPP di RSCM.Metode : Studi kohort retrospektif dengan menelusuri rekam medis pasien yang menjalani IKPP di RSCM periode Januari 2015-Maret 2020. Dilakukan analisa bivariat antara faktor prediktor usia, status merokok, hipertensi, diabetes mellitus, penyakit ginjal kronik, time-to-treatment, kelas killip, fraksi ejeksi ventrikel kiri (FEVK) dan kadar kolesterol LDL dengan kejadian MACE selama perawatan pada pasien STEMI yang menjalani IKPP, menggunakan metode Chi-square. Analisa multivariat dan analisa model prediksi dilakukan dengan metode regresi logistik terhadap variabel dengan nilai p= <0,25 pada analisa bivariat.Hasil : Didapatkan subyek sebanyak 291 pasien untuk diteliti. Major Adverse Cardiac Events selama perawatan didapatkan sebesar 43,3% dengan usia >60 tahun (29,6%), status merokok (61,2%), hipertensi (50,9%), diabetes mellitus (36.1%), penyakit ginjal kronik (6,2%), kelas Killip II-IV (32,2%), FEVK > 50% (57%) dan kadar kolesterol LDL > 100 mg/dl (79,4%). Median time-to-treatment didapatkan sebesar 528 (379-730) menit. Usia, kelas killip dan FEVK mempengaruhi kejadian MACE selama perawatan dengan OR (IK 95%) masing-masing 2,15 (1,22-3,79), 4,34 (2,49-7,56) dan 2,88 (1,72-4,82). Model prediksi MACE selama perawatan pada pasien STEMI yang menjalani IKPP memiliki nilai area under curve (AUC) 0,729 (IK 95% 0,67-0,78).Kesimpulan : Major Adverse Cardiac Events (MACE) selama perawatan pada pasien STEMI yang menjalani IKPP sebesar 43,3%, yang dipengaruhi oleh usia, kelas killip dan FEVK.

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Introduction: Major Adverse Cardiac Events (MACE) is the main causes to increase mortality on ST-Elevation Myocardial Infarction (STEMI) patients who undergo Primary Percutaneous Coronary Intervention (PPCI). In-hospital MACE inducing factor predictors identification is expected to enhance STEMI patients’ care and outcome. This study aims to identify in-hospital MACE factor predictors on STEMI patients with PPCI treatment at RSCM.

Method: Restropective cohort study by tracing medical record on patients with PPCI treatment at RSCM during January 2015 - March 2020. Chi-squared bivariate analysis concluded between predictor factors; age, smoking, hypertension, diabetic mellitus, chronic kidney disease, time-to-treatment, killip class, left ventricle ejection fraction (LVEF) and LDL cholesterol level. Logistic regression is used on multivariat and prediction model analysis on variables with p=<0,25 in bivariate analysis.

Result: This study involves 291 patient subjects. During this study, the occurance of MACE is 43.3% on patients age > 60 years (29,6%), smoking (61,2%), hypertension (50,9%), diabetes mellitus (36,1%), chronic kidney disease (6,2%), killip class II-IV (32,2%), LVEF > 50% (57%) dan cholesterol LDL level > 100 mg/dl (79,4%). Median time-to-treatment is 528 (379-730) minutes. Age, killip class, and LVEF influences in-hospital MACE during PPCI with OR (95% CI) consecutively are 2,15 (1,22-3,79), 4,34 (2,49-7,56) and 2,88 (1,72-4,82). MACE prediction model in this study produces area under curve (AUC) 0,729 (95% CI 0,67-0,78).

Conclusion: In-hospital MACE on STEMI patient after PPCI occurance is 43.3%, influenced by age, killip class, and LVEF."

"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)."

"In-stent restenosis adalah komplikasi yang dapat terjadi setelah pemasangan stent. Penelitian ini bertujuan untuk mengidentifikasi faktor ? faktor yang berhubungan dengan tindakan PCI berulang. Desain penelitian menggunakan desain non eksperimental jenis cross sectional. Responden sebanyak 70 orang, diperoleh melalui teknik consecutive sampling. Analisis data dilakukan secara univariat, bivariat (chi square) serta multivariat (regresi logistik berganda). Hasil penelitian menunjukkan bahwa riwayat merokok memiliki hubungan yang signifikan dan merupakan faktor dominan dengan tindakan PCI berulang. Implikasi dalam keperawatan adalah peningkatan peran perawat sebagai pendidik dalam memberikan pendidikan kesehatan tentang pengendalian faktor risiko yakni kebiasaan merokok pada pasien yang terpasang stent dalam mencegah in-stent restenosis.

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In-stent restenosis is a complication that can occur after stenting. This study aimed to identify factors related to re-PCI. A non-experimental design with cross sectional approach was used in this research, while 70 respondents were obtained through a consecutive sampling technique. Data analyzed was performed using univariate, bivariate (chi square) and multivariate (multiple logistic regression) tests.

The results showed that a history of smoking has a significant relationship with the re-PCI and history of smoking is the dominant factor associated with re-PCI. Implications of the research to nursing is to improve of the role of nurses as educators in providing health education to control risk factors, especially smoking habits in patients who mounted stents in order to prevent in-stent restenosis."

"Latar belakang. Kondisi iskemia pada penyakit jantung koroner (PJK) berkorelasi dengan disfungsi sistem saraf otonom. Revaskularisasi melalui percutaneous coronary intervention (PCI) dapat mengembalikan keseimbangan fungsi saraf otonom dan memperbaiki prognosis. Di sisi lain, perasaan cemas yang muncul menjelang prosedur PCI, dapat memicu hiperaktivitas simpatis. Tujuan penelitian ini adalah untuk mengetahui pengaruh ansietas terhadap perbaikan heart rate variability (HRV), sebuah teknik non-invasif untuk mengevaluasi aktivitas sistem saraf otonom; setelah tindakan PCI. Metode. Studi dengan desain potong lintang, korelasi pretest-posttest; melibatkan 44 subjek dengan PJK stabil yang menjalani PCI elektif di Pelayanan Jantung Terpadu, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Pengukuran HRV dilakukan sebelum PCI, kemudian diulang pasca tindakan PCI. Ansietas dinilai menggunakan kuesioner hospital anxiety depression score (HADS). Pengolahan data serta analisis statistik dilakukan dengan bantuan software SPSS 20.0. Hasil. Sebanyak 54,5% subjek mengalami ansietas saat akan menjalani PCI. Pada kelompok tanpa ansietas, ditemukan perbaikan signifikan pada parameter HRV sebelum-setelah PCI; yaitu SDNN [standard deviation of normal to normal intervals] (Median = 26,19 vs. Median = 39,60 ; Z = -3,621 ; p < 0,001) dan parameter RMSSD [root mean square of the successive differences] (Median = 21,90 vs. Median = 30,99; Z = -2,501; p = 0,012). Sementara itu, tidak didapatkan perbaikan bermakna parameter HRV sebelum-setelah PCI, pada kelompok ansietas. Terdapat perbedaan bermakna pada kenaikan nilai SDNN antara kelompok tanpa ansietas dibandingkan dengan kelompok ansietas ansietas (Median = 9,11 vs. Median = 2,83 ; U = 154,00 ; p = 0,043). Simpulan. Ansietas yang terjadi sebelum PCI elektif dapat menghambat perbaikan HRV pasca tindakan sehingga mempengaruhi prognosis penyakit. Diperlukan penelitian lanjutan mengenai peranan terapi ansietas menjelang PCI dihubungkan dengan luaran klinis serta prognosis pasca PCI.

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Background. Chronic ischemic condition in coronary artery disease (CAD) was associated with autonomic dysfunction. Percutaneous coronary intervention (PCI) could restore perfusion so that improving autonomic balance and disease prognosis. On the other hand, pre-PCI anxiety was known to produce sympathetic hyperactivity. The aim of this study was to determine whether pre-PCI anxiety may influence heart rate variability (HRV) improvement, a noninvasive technique for the evaluation of the autonomic nervous system activity; after successful PCI.

Methods. A cross sectional studies, pretest-posttest correlation; enclose 44 patients with stable CAD undergoing PCI in Integrated Heart Service, Cipto Mangunkusumo National Hospital. HRV measurement was done before and after PCI. Anxiety symptoms was collected using hospital anxiety depression score (HADS) questionnaires. Data input and statistical analysis was carried out using SPSS 20.0 for Windows.

Results. As many as 54.5% stable CAD patients undergoing elective PCI experienced anxiety symptoms. In the anxiety group, there were significant post-PCI improvement of SDNN [standard deviation of normal to normal intervals] (Median = 26.19 vs. Median = 39.60; Z = -3.621; p < 0.001) and RMSSD [root mean square of the successive differences] (Median = 21.90 vs. Median = 30.99; Z = -2.501; p = 0.012). Post-procedure HRV improvement was not significant in patients with anxiety symptoms. There was significant difference of the SDNN improvement between non-anxiety and anxiety patients (Median = 9.11 vs. Median = 2.83; U = 154.00; p = 0.043).

Conclusions. Pre-PCI anxiety may affect HRV improvement after revascularization thus influence disease prognosis. Further studies are needed to determine the impact of pre-PCI anxiety treatment on cardiac outcomes."

"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: Major adverse cardiac events MACE merupakan masalah yang besar yang meningkatkan morbiditas dan mortalitas pada penderita sindrom koroner akut. Belum banyak data MACE pada penderita sindrom koroner akut SKA pasca intervensi koroner perkutan IKP . Tujuan penelitian: mengetahui faktor faktor yang menjadi prediktor MACE 7 hari penderita SKA yang dilakukan IKP. Metode: Untuk mengetahui faktor-faktor yang menjadi prediktor terjadinya major adverse cardiac events pada penderita sindrom koroner akut yang dilakukan intervensi koroner perkutan dilakukan dengan metode kasus kontrol tanpa penyetaraan. Penelitian melibatkan 461 pasien SKA yang dirawat di unit perawatan intensif jantung RSCM dari tanggal 1 Januari 2015 sampai 30 November 2017. Umur, jenis kelamin wanita, diabetes melitus, hipertensi, gagal jantung, gangguan fungsi ginjal, renjatan kardiogenik, fraksi ejeksi le; 40 , stenosis di left main, aritmia, stenosis 3 arteri koronaria, stenosis di left anterior descending artery LAD dan stenosis di left main LM dilakukan penelitian prediktor terjadinya MACE. Hasil: Renjatan kardiogenik OR=10,65 p=0,001 , stenosis LAD OR=15,23 p=0,02 , fraksi ejeksi le; 40 OR=10,8 p=0,00 , faktor stenosis 3 arteri koroner atau lebih OR= 3,47 p=0,01 , gagal jantung OR=3,1 p=0,02 dan gangguan fungsi ginjal OR=4,76 p=0,00 terbukti sebagai prediktor terjadinya MACE 7 hari pada penderita SKA yang dilakukan IKP. Faktor jenis kelamin wanita, renjatan kardiogenik, stenosis LAD dan fraksi ejeksi le; 40 secara independen berhubungan dengam kejadian MACE pada pasien SKA yang dilakukan IKP, secara berturut-turut OR 95 CI 6.33 1.32-30.50 , 17.56 1.85-167.06 , 26.61 1,38-513,81 , dan 7.6 1.86-31.09. Kesimpulan: Renjatan kardiogenik, stenosis LAD, fraksi ejeksi le; 40 , faktor stenosis 3 arteri koroner atau lebih, gagal jantung dan gangguan fungsi ginjal merupakan prediktor terjadinya MACE 7 hari penderita SKA pasca IKP. Renjatan kardiogenik, stenosis LAD, wanita dan fraksi ejeksi le; 40 merupakan prediktor independen terjadinya MACE 7 hari penderita SKA pasca IKP.

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Introduction: Major Adverse Cardiac Events MACE are a big problem increasing morbidity and mortality to acute coronary syndrome patients. There is not much MACE data of acute coronary syndrome ACS patients who underwent percutaneous coronary intervention PCI . Therefore, the researcher investigated predictors factors of major adverse cardiac events.

Objective: To investigate the predictors factors of seven day MACE on ACS patients underwent PCI.

Method: To investigate the predictors factors of seven day MACE on ACS patients underwent PCI, unmatched case control was conducted. The research involved 461 ACS patients who were hospitalized in intensive coronary care unit ICCU RSCM from 1 January 2015 to 30 November 2017. Age, female gender, diabetes mellitus, hypertension, heart failure, renal dysfunction, cardiogenic shock, ejection fraction le 40, left main LM disease, arrhythmia, 3 vessel diseases, and left anterior descending artery LAD stenosis were investigate as the predictors of MACE.

Results: Cardiogenic shock OR 10.65 p 0.001, LAD stenosis OR 15.23 p 0.02 , ejection fraction le 40 OR 10.8 p 0.00 , 3 vessel diseases OR 3.47 p 0.01 , heart failure OR 3.1 p 0.02 and renal dysfunction OR 4.76 p 0.00 had been as the predictors of seven day MACE on ACS patients underwent PCI. Factors of female gender, cardiogenic shock, LAD stenosis and ejection fraction le 40 were independently predictors of seven day MACE on ACS patients underwent PCI OR 95 CI 6.33 1.32 30.50, 17.56 1.85 167.06, 26.61 1.38 513.81, and 7.6 1.86 31.09 respectively.

Conclusions: Cardiogenic shock, LAD stenosis, ejection fraction le 40, 3 vessel diseases or more, heart failure and renal dysfunction were the predictors of seven day MACE on ACS patients underwent PCI. Cardiogenic shock, LAD stenosis, female gender and ejection fraction le 40 were independent predictors of seven day MACE on ACS patients underwent PCI. The other factors were not significant."

"[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 : Setengah pasien IMA-EST yang menjalani intervensi koroner perkutan primer(IKPP) memiliki multivessel disease. Rekomendasi saat ini hanya menganjurkan intervensi pada arteri terkait infark pada saat IKPP. Revaskularisasi selanjutnya pada stenosis signifikan lainnya dapat dilakukan dengan intervensi koroner perkutan (IKP) atau bedah pintas arteri koroner (BPAK). Namun sampai saat ini belum ada panduan pemilihan tindakan paska IKPP dengan multivessel disease. Tujuan : Mendapatkan data yang akurat tentang mortalitas IKP dan BPAK pada stenosis multipel paska IKPP. Melalui data ini diharapkan didapatkan rekomendasi yang sesuai tentang pilihan strategi pada stenosis multipel paska IKPP. Metode : Penelitian ini merupakan studi kohort retrospektif observasional. Penelitian dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) dengan mengambil data dari rekam medis. Durasi data yang diambil dari 01 Januari 2011 - 31 Desember 2014. Data karakteristik dasar, data klinis, dan angiografi dicatat dari rekam medis dan melalui wawancara melalui telepon. Data kemudian diolah dengan analisis bivariat dan multivariat untuk melihat hubungan kedua jenis tindakan dan mortalitas. Hasil Penelitian : Terdapat 177 pasien yang memenuhi kriteria dengan 141 pasien yang dilakukan IKP dan 36 pasien dilakukan BPAK paska IKPP. Karakteristik dasar tidak berbeda diantara kedua kelompok. Data klinis dan angiografi menunjukkan perbedaan culprit lesion (p=0,007), residual lesion (p<0,001), dan jumlah vessel (p<0,001). Data pre tindakan ulang menunjukkan perbedaan interval waktu tindakan (p=0,042) dan lesi Left Main (LM) atau proksimal left anterior descending (LAD) (p=0,032). Mortalitas terjadi pada 14,2% pada kelompok IKP dan 27,8% pada kelompok BPAK (RR 1,96; 95% IK 1,01-3,81). Hasil analisis bivariat menunjukkan bahwa diabetes mellitus (RR 1,18; 95% IK 1,03-1,36), fraksi ejeksi (RR 1,18; 95% IK 1,01-1,38), lesi residual LM atau proksimal LAD (RR 2,43; 95% IK 1,08-5,48), dan nilai kreatinin saat tindakan ulang (p=0,027) memiliki pengaruh terhadap mortalitas selain BPAK. Hasil multivariat regresi logistik biner dan cox regression didapatkan bahwa DM (aOR 2,67; 95% IK 1,145-6,248), lesi LM atau proksimal LAD (aOR 2,49; 95% IK 1,078-5,762), dan fraksi ejeksi (aOR 2,43; 95% IK 1,067-5,567) yang berpengaruh terhadap mortalitas. Kesimpulan : Mortalitas BPAK dan IKP tidak berbeda secara statistik pada pasien paska IKPP dengan multivessel disease. Perbedaan angka mortalitas disebabkan karena adanya perbedaan lesi residual pada LM atau proksimal LAD yang dari awal merupakan karakteristik pre tindakan ulang yang berbeda diantara kedua kelompok. DM dan fraksi ejeksi konsisten menyebabkan mortalitas pada kedua kelompok dan tidak berbeda bermakna pada kedua kelompok.

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Background : Almost half of the patients with STEMI that undergo Primary Percutaneous Coronary Intervention (PPCI) have multivessel disease. Currently, the only recommendation is to intervene in the infarct related artery at the time of PPCI. The next revascularization on other significant stenosis can be done with Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG). However, the guideline in selecting intervention post PPCI with multivessel disease is currently unavailable.

Objective : To obtain accurate data of mortality in PCI and CABG on patient with multivessel disease post PPCI. The data is expected to obtain reasonable recommendation of selection strategy on multiple stenosis post PPCI.

Methods : This study is an observational retrospective cohort. The research was done by retrieving medical record data of catheterization laboratory divison at the Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) from 1st January 2011 to 31st December 2014. Basic characteristics data, clinical data, and angiography were recorded from medical records and interviewes through telephone. The data is then processed by bivariate and multivariate analyzes to obtain the relationship between two types of modality and mortality.

Results : There were 177 eligible post PPCI patients, 141 patients undergoing PCI and 36 patients undergoing CABG. The baseline characteristics are no different between the two groups. Clinical data and angiography show a difference culprit lesion (p = 0.007), residual lesions (p<0.001), and the number of vessel (p <0.001). Pre intervention data shows the intervention time interval difference (p = 0.042) and the Left Main lesion (LM) or proximal left anterior descending (LAD) (p = 0.032). Mortality occurred in 14.2% and 27.8% in the PCI and CABG group (RR 1.96; 95% CI 1.01 to 3.81). The results of bivariate analyzes shows that diabetes mellitus (RR 1.18; 95% CI 1.03 to 1.36), ejection fraction (RR 1.18; 95% CI 1.01 to 1.38), residual lesions LM or proximal LAD (RR 2.43; 95% CI 1.08 to 5.48), and creatinine values before intervention (p = 0.027) had an significant influence on mortality other than CABG. The results of multivariate binary logistic regression and cox regression shows that DM (aOR 2.67; 95% CI 1.145 to 6.248), LM or proximal LAD lesion (aOR 2.49; 95% CI 1.078 to 5.762), and ejection fraction (aOR 2 , 43; 95% CI 1.067 to 5.567) effect on mortality.

Conclusion : Mortality in PCI and CABG were not statitically different for the post PPCI patients with multivessel disease. The difference on mortality was caused by the difference of residual lesions on the LM or proximal LAD which is the characteristic of different pre reintervention in the two types of modality. DM and the ejection fraction were consistently cause mortality in both groups and not significantly different in both groups."