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"Latar Belakang. Stratifikasi risiko merupakan bagian integral dari managemen pasien sindrom koroner akut (SKA). Identifikasi pasien yang berisiko tinggi menjadi sangat penting untuk meningkatkan kewaspadaan sekaligus mengurangi tindakan berlebih terhadap pasien dengan risiko rendah. Meskipun TIMI pada STEMI dan UAPINSTEMI merupakan skor risiko yang baik dan telah divalidasi dan dipergunakan secara luas, tetapi penelitian mengenai perfonnanya belum pernah dilakukan di Indonesia. Adanya perbedaan karakteristik antara pasien SKA di Indonesia dengan populasi di negara maju dapat mempengaruhi prognosis pasien sehingga perlu dilakukan penelitian mengenai perfonna dari kedua sistem skoring tersebut. Tujuan. Menilai perfonna kalibrasi dan diskriminasi skor TIMI dalam memprediksi mortalitas 30 hari pasien STEMI dan 14 hari pasien UAPINSTEMI di Indonesia Metodologi. Studi kohort retrospektif menggunakan data rekam medis pasien SKA yang dirawat di IeeU RSeM 2003-2010 dengan metode pengambilan sampel konsekutif. Perfonna kalibrasi skor TIMI dinyatakan dengan plot kalibrasi dan uji Hosmer-Lemeshow sedangkan perfonna diskriminasi dinyatakan dengan nilai AUe. Hasil. Selama penelitian terkumpul 714 pasien STEMI dan 787 pasien UAPINSTEMI yang dirawat di IeeU RSeM. Skor TIMI STEMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dengan plot kalibrasi 0,98, uji Hosmer-Lemeshow 0,93 dan nilai AUe 0,801 (Kl 95% 0,759-0,844). Perfonna kalibrasi dan diskriminasi skor TIMI UAPINSTEMI juga cukup baik dengan plot kalibrasi mencapai 0,88, uji Hosmer lemeshow 0,86 dan nilai AUe 0,727 (KI95% 0,668-0,786). Simpulan. Skor TIMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas pasien SKA di Indonesia.

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Background. Risk Stratification in acute coronary syndrome patients is an integral part in the management of patients. Risk stratification is important to avoid overtreatment in high risk patients, as well as undertreatment in low risk patients. Although TIMI STEMI and TIMI UAiNSTEMI are scores that have been validated and used widely, but to date no study of its appicability has been done in Indonesia. Differences in characteristic of acute coronary syndrome patients in Indonesia compared to developed countries can have influence on the prognostic of the patient hence a study is needed regarding performance of TIM I scoring system. Objectives. To obtain the calibration dan discrimination performance of TIMl risk score to predict 30 day dan 14 day mortality in STEMI and UAPINSTEMI patients in Indonesia Methods. A retrospective cohort study with consecutive sampling was done in ACS patients hospitalized in the ICCU Cipto Mangun Kusumo Hospital between the period 2003 until 2010. Calibration performance of TIM I risk score was evaluated by calibration plot and Hosmer-Lemeshow test while discrimination performance was done with A Uc. Results. A total of 714 STEMI patients and 787 UAPINSTEMI patients entered the study. TIMI STEMI risk score have a good calibration and discrimination performance with calibration plot of 0, 98, Hosmer-Lemeshow test 0,93 and AUC 0,801 (CI95% 0,759-0,844). A good calibration and discrimination performance of TIMI UAPINSTEMI risk score was observed with calibration plot of 0,88, Hosmer-Lemeshow test 0,86 and AUC 0,73 (CI 95% 0,668-0,786). Conclusion. TIM! risk score has a good calibration and discrimination performance in predicting mortality of ACS patients in Indonesia."

"ABSTRAKLatar belakangPenyakit jantung Koroner (PJK) merupakan penyebab kematian yang tertinggi di dunia dan cenderung meningkat dari tahun ke tahun. Skor TIMI STEMI sudah banyak digunakan dan divalidasi sebagai prediktor kematian pasien STEMI namun belum mencakup komponen fraksi ejeksi ventrikel kiri (FEVK) dan laju filtrasi glomerulus (LFG), dan kurang optimal dalam penggunaanya.TujuanMemodifikasi skor TIMI STEMI dengan memasukkan variabel FEVK dan LFG sebagai prediktor mortalitas pada pasien STEMI dalam 30 hari di RSCM. Metode Studi kohort retrospektif terhadap 487 pasien STEMI yang di rawat di RSUPN Cipto Mangunkusumo pada periode 2004-2013. Data variabel prediktor diperoleh dari penelusuran rekam medis. Data yang didapatkan dianalisis secara bivariat dan multivariat, setelah itu dibuat formulasi baru prediktor mortalitas pasien STEMI dalam 30 hari dan akan diujikan pada seluruh data dan dinilai risiko mortalitasnya serta dibandingkan dengan skor TIMI dengan AUC (area under curve).HasilDari analisis secara bivariat dan multivariat didapat hanya dua variabel yang dapat digunakan dalam formula baru yaitu kelas killips II-IV dan LFG dengan kisaran total skor 0-4.6 Stratifikasi risiko mortalitas dalam 30 hari pada pasien STEMI adalah tinggi (total skor >3,5; 46,5%), sedang (total skor 2,5-3,5;23,2%), dan rendah (total skor <2,5;5,95%). Diskriminasi modifikasi skor TIMI STEMI dengan AUC 0.816; IK 95%; 0.756-0.875.KesimpulanModifikasi skor TIMI STEMI terdiri dari dua variabel yaitu kelas Killip dan LFG. Modifikasi ini memiliki kalibrasi dan diskriminasi yang baik sebagai prediktor mortalitas 30 hari pada pasien STEMI.

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ABSTRACTBackgroundCoronary Heart Disease (CHD) is the leading cause of death in the world and the rate increases every year. TIMI STEMI score has been used and validated as mortality predictor for STEMI patient but unfortunately, it does not involve left ventricle ejection fraction (LVEF) and Glomerulus filtration rate (GFR), thus it is less optimal in clinical setting.ObjectiveTo modify TIMI STEMI score include LVEF and GFR as variables for 30 day mortality predictor STEMI patients in RSUPN Cipto Mangunkusumo Hospital. Methods Retrospective cohort study was done toward 487 STEMI inpatients in RSUPN Cipto Mangunkusumo Hospital in 2004-2013. Predictor variable data was obtained from medical records. The data was analyzed with bivariate and multivariate method using Cox’s Proportional Hazard Regression Model. Subsequently, formulate new predictors for STEMI patient mortality rate in 30 days. In these newly formulated predictors shall be stratified to all data and mortality risk shall be assessed and compared with current TIMI STEMI Score using area under curve (AUC).ResultsFrom bivariate and multivariate analysis, only two variables were found to have significant values for new formulation; Killip class II-IV and GFR which contribute 0.4.6 of total score value. 30 day mortality risk stratification for STEMI patient is high if total score > 3.5;46.5%, moderate if total score 2.5-3.5;23.2% and low if total score < 2.5;5.95%. Modified TIMI STEMI Score has a good discrimination rate with AUC value of 0.816 (0.756-0.875) and confidence interval (CI) 95%.ConclusionModified TIMI STEMI Score has two variables such as Killip Class and GFR. It has good calibration and discrimination for 30 day mortality predictor in STEMI patients."

"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. 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."

"Latar Belakang: Sindrom Koroner Akut (SKA) merupakan kondisi aliran darah menuju miokardium tidak terpenuhi, yang bertanggung jawab atas lebih dari 7 juta kematian di dunia setiap tahun. Skor risiko TIMI adalah alat stratifikasi untuk pasien SKA yang menilai berbagai faktor risiko untuk menetapkan prognosis. Kadar natrium dan kalium dalam darah telah ditemukan sebagai indikator dalam prognosis pada pasien SKA. Penelitian ini bertujuan untuk mencari asosiasi antara natrium dan kalium dalam darah dengan skor risiko TIMI pada pasien SKA, beserta kegunaannya sebagai faktor prognosis. Metode: Penelitian ini menerapkan studi analitik cross-sectional yang menggunakan data sekunder melalui rekam medik RSCM, yang termasuk pasien SKA dengan hasil skor risiko TIMI, dan kadar natrium serta kalium darah saat admisi pasien. Analisis data menggunakan 111 sampel data dengan program SPSS20. Hasil: Asosiasi antara kadar serum natrium saat admisi dengan skor risiko TIMI disebut signifikan secara statistik (p=0.013). Namun, asosiasi antara kadar serum kalium saat admisi dengan skor risiko TIMI tidak memiliki makna yang signifikan secara statistik (p=0.286). Kesimpulan: Analisis memperlihatkan asosiasi yang bermakna secara statistik dalam kadar natrium darah pada subjek saat admisi dengan skor risiko TIMI. Tidak ada asosiasi yang signifikan antara kadar kalium darah pada subjek saat admisi dengan skor risiko TIMI.

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Introduction: Acute Coronary Syndrome (ACS) is a condition of inadequate blood supply of the myocardium, which responsible for the death of 7 million people each year worldwide. TIMI risk score is a risk stratification tool for ACS patients that assess multiple risk factor to establish the prognosis. The serum sodium and potassium level have been found as indicators of prognosis among ACS patients. This research intends to discover the association between serum sodium and potassium with TIMI risk score in ACS patients and its utilization as a prognostic factor. Method: This research applies an analytical cross-sectional study that utilize secondary data that was taken from the medical record of RSCM, which consists of ACS patients with TIMI risk score, admission serum sodium level, and admission serum potassium level. Data analysis uses 111 sample data with SPSS20 program. Results: Association between admission serum sodium level with TIMI risk score is statistically significant (p=0.013). However, admission serum potassium level with TIMI risk score has no statistical significance (p=0.286). Conclusion: It prevail the statistical significance on the association of subjects’ serum sodium level with TIMI risk score. There is no significant association between the subjects’ serum potassium level and TIMI risk score."

"Latar Belakang: Sindrom Koroner Akut (SKA) merupakan kondisi aliran darah menuju miokardium tidak terpenuhi, yang bertanggung jawab atas lebih dari 7 juta kematian di dunia setiap tahun. Skor risiko TIMI adalah alat stratifikasi untuk pasien SKA yang menilai berbagai faktor risiko untuk menetapkan prognosis. Kadar natrium dan kalium dalam darah telah ditemukan sebagai indikator dalam prognosis pada pasien SKA. Penelitian ini bertujuan untuk mencari asosiasi antara natrium dan kalium dalam darah dengan skor risiko TIMI pada pasien SKA, beserta kegunaannya sebagai faktor prognosis. Metode: Penelitian ini menerapkan studi analitik cross-sectional yang menggunakan data sekunder melalui rekam medik RSCM, yang termasuk pasien SKA dengan hasil skor risiko TIMI, dan kadar natrium serta kalium darah saat admisi pasien. Analisis data menggunakan 111 sampel data dengan program SPSS20. Hasil: Asosiasi antara kadar serum natrium saat admisi dengan skor risiko TIMI disebut signifikan secara statistik (p=0.013). Namun, asosiasi antara kadar serum kalium saat admisi dengan skor risiko TIMI tidak memiliki makna yang signifikan secara statistik (p=0.286). Kesimpulan: Analisis memperlihatkan asosiasi yang bermakna secara statistik dalam kadar natrium darah pada subjek saat admisi dengan skor risiko TIMI. Tidak ada asosiasi yang signifikan antara kadar kalium darah pada subjek saat admisi dengan skor risiko TIMI.

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Introduction: Acute Coronary Syndrome (ACS) is a condition of inadequate blood supply of the myocardium, which responsible for the death of 7 million people each year worldwide. TIMI risk score is a risk stratification tool for ACS patients that assess multiple risk factor to establish the prognosis. The serum sodium and potassium level have been found as indicators of prognosis among ACS patients. This research intends to discover the association between serum sodium and potassium with TIMI risk score in ACS patients and its utilization as a prognostic factor. Method: This research applies an analytical cross-sectional study that utilize secondary data that was taken from the medical record of RSCM, which consists of ACS patients with TIMI risk score, admission serum sodium level, and admission serum potassium level. Data analysis uses 111 sample data with SPSS20 program. Results: Association between admission serum sodium level with TIMI risk score is statistically significant (p=0.013). However, admission serum potassium level with TIMI risk score has no statistical significance (p=0.286). Conclusion: It prevail the statistical significance on the association of subjects’ serum sodium level with TIMI risk score. There is no significant association between the subjects’ serum potassium level and TIMI risk score."

"Studi mengenai pemberian klopidogrel sebelum angiografi koroner (pretreatment) pada pasien infark miokard akut dengan elevasi segmen ST (IMA-EST) yang akan menjalani intervensi koroner perkutan primer (IKPP) terbatas, namun dapat disimpulkan bahwa aman dan dapat penurunan angka major adverse cardiovascular events (MACE). Pada studi yang dilakukan beberapa tahun terakhir, manfaat pemberian klopidogrel pretreatment dipertanyakan. Studi yang telah ada dilakukan di negara lain berbeda dengan kondisi di Indonesia; terdapat perbedaan karakteristik seperti waktu onset nyeri dada hingga pasien sampai ke fasilitas kesehatan primer, loading antiplatelet, serta dilakukan tindakan IKPP yang lebih panjang. Penelitian ini bertujuan untuk mengetahui hubungan pemberian klopidogrel pretreatment  dengan TIMI-flow pasien IMA EST yang menjalani IKPP. Studi potong lintang retrospektif terhadap 220 pasien IMA EST dilakukan di rumah sakit Jantung dan Pembuluh Darah Harapan Kita sejak tanggal 1 Januari - 30 Oktober 2018 dengan membagi subjek dalam kelompok klopidogrel pretreatment (600 mg klopidogrel diberikan > 120 menit sebelum angiografi koroner) dan kelompok yang diberikan < 120 menit. Analisis multivariat menunjukkan bahwa klopidogrel pretreatment merupakan prediktor utama yang mempengaruhi TIMI flow sebelum tindakan IKPP (OR 0.273, 95% CI 0.104-0.716; p=0.008). Pemberian klopidogrel pretreatment berhubungan dengan TIMI flow sebelum tindakan IKPP, namun tidak berpengaruh terhadap TIMI setelah dilakukan tindakan IKPP. 

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Immediate antiplatelet administration is the standard therapy used in acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Studi on clopidogrel pretreatment are limited, but it can be concluded that was safe, also reduced the number of major adverse cardiovascular events (MACE). Recently, pretreatment with P2Y12 are questioned. There are differences in the background and the conditions between the studies that have been conducted and the condition in Indonesia; such as duration of angina onset until arrive at primary health care, time of loading antiplatelet and longer ischemic time.

This study sought to evaluate the association between clopidogrel pretreatment and TIMI flow of patients with acute STEMI undergoing primary PCI. Single-center retrospective cross sectional study of 220 patients with acute STEMI were conducted in National Centre of Cardiovascular Harapan Kita, Indonesia from 1 January-30 October 2018. Subjects are devided into two groups: clopidogrel pretreatment (≥ 120 minute from coronary angiography conducted) and non pretreatment group (<120 minute). Multivariate analysis revealed that clopidogrel pretreatment is the main predictor of preprocedural TIMI grade flow (OR 0.273, 95% CI 0.104-0.716; p=0.008). Clopidogrel pretreatement was associated with TIMI flow grade pre intervention, but not with TIMI flow grade post intervention."

"ABSTRAK Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanyalebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuahperangkat yang memiliki peran penting dalam prognosis mortalitas PJK. SkormACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.Informasi tersebut berguna dalam menentukan prioritas tindakan angiografikoroner. Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagaiprediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yangmengalami sindrom koroner akut (SKA). Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCMtahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan denganmenggunakan Receiver Operating Characteristic (ROC) curves dengan intervalkepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengancara menghitung sensitivitas, spesifisitas, RKP, dan RKN. Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%. Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGKstadium 3 dan 4 yang mengalami SKA adalah 2,288. Akurasi diagnostik skor mACEF dinilai baik.ABSTRACT Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively."

"Latar Belakang: Sindrom koroner akut (SKA) dapat didefinisikan sebagai aliran darah yang tidak cukup ke miokardium dan salah satu penyakit kardiovaskular yang paling umum di Indonesia yang mempengaruhi 143.000 orang. Skor risiko TIMI adalah penilaian stratifikasi risiko yang dapat menentukan prognosis pasien dan memengaruhi opsi terapi. Tes fungsi ginjal dikaitkan dengan keparahan hipoksia dan faktor-faktor lain yang berkontribusi dalam SKA dan tidak termasuk dalam skor risiko TIMI. Penelitian ini bertujuan untuk melihat hubungan antara tes fungsi ginjal dan skor risiko TIMI pada pasien SKA. Metode: Penelitian ini menggunakan model analitik cross-sectional menggunakan pengumpulan data rekam medis yang meliputi serum kreatinin, serum ureum, dan skor risiko TIMI yang diperoleh dari Rumah Sakit Nasional Cipto Mangunkusumo. 117 sampel diperoleh yang kemudian dianalisis dengan uji chi-square. Hasil: Uji fungsi ginjal terbukti secara signifikan terkait dengan Skor Risiko TIMI. Serum kreatinin dikaitkan dengan skor risiko TIMI (p = 0,0407) serta serum ureum juga dikaitkan dengan skor risiko TIMI (p = 0,036). Kesimpulan: Terdapat hubungan antara serum kreatinin dan serum ureum yang tinggi dengan tingginya skor risiko TIMI.

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Background: Acute coronary syndrome (ACS) is defined as insufficient blood flow to the myocardium and one of the most common cardiovascular disease in Indonesia affecting 143.000 people. TIMI risk score is risk stratification assessment that can determine the prognosis of the patient and affect therapy options. Renal function test is associated with hypoxia severity and other contributing factors in ACS which is not included in TIMI risk score. This research aims to see the association of renal function test and TIMI risk score in ACS patients.

Method: The research uses analytical cross-sectional model using medical records data collection which encompasses serum creatinine, serum ureum, and TIMI risk score obtained from Cipto Mangunkusumo National Hospital. 117 samples are obtained which is then analysed using chi-square test.

Results: Renal function test proved to be significantly associated with TIMI Risk Score. Serum creatinine is associated with TIMI risk score (p=0,0407) as well as serum ureum is also associated with TIMI risk score (p=0,036).

Conclusion: There is an association between high serum creatinine and high serum ureum with TIMI risk score in ACS patients."

"Dijumpainya late potential (LP) pada penderita-penderita pasca Infark Miokard Aleut (IMA) sangat berhubungan dengan meningkatnya risiko takikardia ventrikel (Ventricular tachycardia=VT) dan kematian jantung mendadak. Trombolisis telah terbukti menurunkan kematian. Tujuan penelitian ini adalah untuk menilai pengaruh terapi trombolisis terhadap kejadian LP. Dilakukan penelitian prospektif observasional terhadap 60 penderita IMA pertama, secara konsekutif di RS Jantung Harapan Kita dan RS Pusat Pertamina pada periode 20 Oktober 1995 sampai dengan 20 April 1996. Sebanyak tiga puluh penderita (semua laki-laki, rata-rata umur 49,1 ± 5,6 tahun) mendapat streptokinase intra vena (kelompok trombolisis) dan sebanyak 30 penderita lainnya (semua laki-laki, rata-rata umur 50,7 ± 5,7 tahun) mendapat pengobatan konservatif saja (kelompok non trombolisis). Pemeriksaan kateterisasi koroner dilakukan terhadap 26 (70 %) penderita dari kelompok trombolisis dan 15 (50 %) penderita kelompok non trombolisis. LP diperiksa menurut metode Simson (time domain analysis), menggunakan mesin Marquette Electronic type 15.

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The presence of late potential (LP) in patients after Myocardial Aleut Infarction (IMA) is strongly associated with an increased risk of ventricular tachycardia (Ventricular tachycardia = VT) and sudden cardiac death. Thrombolysis has been shown to lower mortality. The purpose of this study is to assess the effect of thrombolysis therapy on the incidence of LP. An observational prospective study was conducted on the first 60 IMA patients, consequentially at Harapan Kita Heart Hospital and Pertamina Central Hospital in period from October 20, 1995 to April 20, 1996. A total of thirty patients (all males, average age 49.1 ± 5.6 years) received intravenous streptokinase (thrombolysis group) and as many as 30 other patients (all men, average age 50.7 ± 5.7 years) received conservative treatment only (non-thrombolysis group). Coronary catheterization examination was carried out on 26 (70%) patients from the thrombolysis group and 15 (50%) patients from the non-thrombolysis group. LP was examined according to the Samson method (time domain analysis), using a Marquette Electronic type 15 machine."