Hasil Pencarian  ::  Simpan CSV :: Kembali

Hasil Pencarian

Ditemukan 159566 dokumen yang sesuai dengan query
cover
Ngakan Nyoman Rai Bawa
Analisis faktor yang dapat dimodifikasi (Modifiable Factors) yang berhubungan dengan kejadian Sindrom Koroner Akut (SKA) usia dewasa muda di Bali = Analysis of modifiable factors related to the incidence of Acute Coronary Syndrome (ACS) in young adults in Bali
"Prevalensi Sindrom Koroner Akut (SKA) yang merupakan penyakit jantung iskemik paling kritis menjadi sumber utama morbiditas dan mortalitas di seluruh dunia, meningkat secara signifikan setiap tahunnya di Indonesia termasuk Bali pada kelompok usia dewasa muda. Identifikasi faktor resiko yang bisa dimodifikasi seperti kebiasaan merokok, mengonsumsi minuman beralkohol dan makanan olahan yang membudaya menjadi bagian penting untuk pembuatan strategi pencegahan primer, terjadinya serangan dan pencegahan sekunder mengurangi readmision. Penelitian ini bertujuan mengidentifikasi faktor yang dapat dimodifikasi berhubungan dengan kejadian SKA usia dewasa muda di Bali. Penelitian kuantitatif ini menggunakan desain cross sectional dengan studi deskriptif-analitik, dan teknik consecutive sampling pada 150 responden sesuai kriteria inklusi. Hasil penelitian menunjukkan terdapat hubungan signifikan antara Hipertensi, Diabetes Mellitus, Dislipidemia, Hiperuresemia, Diet, Aktivitas fisik, Obesitas, Merokok, Konsumsi Alkohol, Stres, dan Kualitas Tidur. Faktor yang paling berhubungan dengan kejadian SKA pada dewasa muda di Bali adalah Hipertensi (OR=6,785). Rekomendasi diharapkan penelitian lanjutan terkait faktor lain yang dapat mempengaruhi kejadian SKA dewasa muda di Bali seperti kardiososial serta strategi pencegahan dan pengendalian berbasis budaya Bali.
The prevalence of acute coronary syndrome (ACS), which is the most critical ischemic heart disease and the main source of morbidity and mortality in the world, it increases significantly every year in Indonesia, including young adult in Bali. Modifiable risk factors, such as the habit smoking habits, consuming alcohol drinks and processed foods is an important part of primary prevention strategy of attacks and secondary prevention of reducing readmissions. This study aims to identify modifiable factors that are associated with the incidence of acute coronary syndrome (ACS) in young adults in Bali. This quantitative research used a cross-sectional design with a descriptive-analytic study and a consecutive sampling technique on 150 respondents according to the inclusion criteria. Data analysis used descriptive analysis, chi-square test, and logistic regression. The results showed that there was a significant association between Hypertension, Diabetes Mellitus, Dyslipidemia, Hyperurecemia, Diet pattern, Physical activity, Obesity, Smoking, Alcohol consumption, Stress, and Sleep Quality. The most factor associated with the incidence of ACS in young adults in Bali is hypertension (OR=6.785). Recommendations for further research regarding other factors that can affect the incidence of ACS such as cardio-social in young adults in Bali as well as prevention and control strategies based on Balinese culture."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2024
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Nanda Iryuza
Sistem penilaian resiko perdarahan pasca intervensi koroner perkutan primer trans-radial pada infark miokard akut dengan elevasi segmen st = Trans radial primary percutaneous coronary intervention bleeding risk score in st segment elevation myocardial infarction
"ABSTRAK
Latar Belakang. IMA-EST merupakan salah satu manifestasi SKA yang fatal.Terapi reperfusi diindikasikan terhadap pasien dengan IMA-EST dengan awitankurang dari 12 jam. Perdarahan merupakan faktor resiko independen mortalitaspasca IKPP. Perdarahan mayor memperburuk prognosis, meningkatkan lamanyawaktu rawat dan meningkatkan biaya perawatan. Saat ini, penggunaan aksestrans-radial saat IKPP lebih diutamakan dan penghambat Gp2b3a tidak rutindigunakan. Walaupun demikian, kejadian perdarahan pada IMA-EST tetap sajameningkatkan tiga kali lipat resiko kematian. Sampai saat ini belum ada sistempenilaian khusus yang menilai resiko perdarahan pasca IKPP trans-radial.Metode. Penelitian kohort retrospektif dilaksanakan di Rumah Sakit PusatJantung dan Pembuluh Darah Nasional Harapan Kita. Data yang diambilmerupakan kasus IKPP trans-radial pada IMA-EST periode Januari 2011 ndash;Agustus 2016. Definisi perdarahan menggunakan definisi Bleeding AcademicResearch Consortium BARC . Pengolahan data dilakukan dengan analisisbivariat untuk menguji hubungan variabel-variabel independen dengan kejadianperdarahan, lalu dilakukan analisis multivariat. Pemilihan model akhir dilakukandengan metode backward selection dan dilakukan pembobotan untuk membentuksuatu sistem penilaian. Dilakukan validasi internal terhadap sistem penilaian inimenggunakan metode bootsrapping.Hasil. Sejumlah 1035 sampel dikumpulkan, 49 4.7 kasus di antaranyamengalami perdarahan. Didapatkan 6 faktor yang dapat dijadikan prediktorindependen terhadap kejadian perdarahan pasca IKPP trans-radial, yaitu : IMT 2, usia ge; 62 tahun, hitung leukosit ge; 12.000 10/ L,nilai hemoglobin Hb < 13 g/dL, dan nilai kreatinin ge; 1.5 mg/dL. Uji kalibrasidan validasi internal terhadap studi menunjukkan hasil yang baik.Kesimpulan. Sistem penilaian resiko perdarahan pasca IKPP trans-radial inimemiliki hasil uji kalibrasi, uji diskriminasi, dan validasi internal yang cukupbaik. Sistem penilaian ini diharapkan dapat digunakan sebagai salah satu strategipencegahan perdarahan pasca IKPP trans-radial pada kasus IMA-EST.
ABSTRACT
Background STEMI is a fatal manifestation of acute coronary syndrome.Reperfusion therapy is indicated for acute STEMI patient within less than 12hours rsquo onset of chest pain. Bleeding is an independent mortality risk as acomplication of primary PCI. Major bleeding worsens the prognosis, prolonglength of hospital stay, and increase the cost of care. Nowadays, trans radialaccess during primary PCI is a priority and the use of Gp2b3a inhibitor is nolonger used routinely. However, post primary PCI bleeding event nonethelesstripled the risk of death. Until now, there has been no system of assessments thatmeasure the risk of post primary PCI bleeding in specific trans radial accesspopulation.Method Data from 1035 post trans radial primary PCI STEMI patients enrolledfrom a cohort retrospective study performed in National Cardiovascular CenterHarapan Kita between January 2011 and August 2016. BARC bleeding definitionwas utilized to standardized the identification of bleeding events. Statisticalanalysis done by performing bivariate analysis to identify the relationship of eachvariables to the bleeding event, then multivariate analysis was done using logisticregression before the scoring system developed. Internal validation was performedby bootstrapping tecnique.Results 4.7 from 1035 sample experienced bleeding event. 6 factors related tobleeding event post trans radial primary PCI were identified BMI 18.5 kg m2,KILLIP class 2, age ge 62, WBC ge 12.000 10 3 L, hemoglobin 13 g dL, andcreatinine ge 1.5 mg dL. Calibration test and internal validation of this studyshowing good result.Conclusion This trans radial Primary PCI bleeding risk score has a good resultof calibration test, discrimination test, and internal validation. This scoring systemis expected to be applied as one of bleeding avoidance strategies in trans radialprimary PCI in STEMI patients."
2016
T55655
UI - Tugas Akhir  Universitas Indonesia Library
cover
Angga Pramudita
Nilai Diagnostik Waktu Puncak Gelombang P (PWPT) dan Interval Puncak Gelombang T dengan Akhir Gelombang T (Tp-e) pada Pasien Sindrom Koroner Akut untuk Mendeteksi Disfungsi Diastolik Signifikan = Diagnostic Value of P Wave Peak Time (PWPT) Duration and T Wave Peak to T Wave End (Tp-e) Interval to Detect Significant Diastolic Dysfunction in Patients With Acute Coronary Syndrome
"Latar Belakang: Disfungsi diastolik signifikan (derajat 2 dan 3) merupakan komplikasi yang relatif sering ditemukan dan prediktor mortalitas independen pada sindrom koroner akut (SKA). Pemeriksaan ekokardiografi untuk evaluasi disfungsi diastolik tidak selalu dapat dilakukan dan tidak tersedia luas di berbagai tingkat fasilitas pelayanan kesehatan. Pemeriksaan elektrokardiogram (EKG) lebih luas tersedia dan telah ditunjukkan pada penelitian sebelumnya memiliki nilai diagnostik sebagai skrining disfungsi diastolik pada pasien hipertensi dan penyakit ginjal kronik
Tujuan: Tujuan penelitian ini untuk menilai apakah parameter EKG waktu puncak gelombang P (PWPT) dan waktu dari puncak hingga akhir gelombang T (Tp-e) dapat digunakan sebagai skrining disfungsi diastolik signifikan pada pasien sindrom koroner akut.
Metode: Data sekunder (ekokardiogram dan EKG yang diperiksakan pada hari yang sama) dari 93 pasien SKA yang dirawat di ruang rawat intensif koroner dari Januari 2020 hingga Januari 2021 dianalisis dalam studi cross-sectional ini. PWPTV1 didefinisikan sebagai waktu dari awal gelombang P hingga mencapai puncaknya (diukur di sandapan V1). Tp-e didefinisikan sebagai waktu dari puncak gelombang T hingga akhir gelombang T (diukur di V5). Peneliti yang menilai EKG tidak mengetahui hasil ekokardiogram (blinding). Parameter EKG dan variabel lain dibandingkan di antara grup SKA dengan dan tanpa disfungsi diastolik signifikan.
Hasil: Terdapat 32,3% pasien SKA dengan disfungsi diastolik signifikan. Durasi PWPTV1 memanjang pada kelompok SKA dengan disfungsi diastolik signifikan (65 vs. 59 miliseconds, p<0.01). PWPTV1 memiliki korelasi dengan indeks volume atrium kiri (LAVI) (r=0,283, p=0,019) and merupakan prediktor independen terhadap disfungsi diastolik signifikan (OR=1,062, p=0,035). Sebaliknya Tp-e tidak didapatkan memilki perbedaan signifikan diantara kedua kelompok dan tidak berkorelasi dengan parameter disfungsi diastolik pada ekokardiografi. Analisis receiver operating characteristics (ROC) PWPTV1 menunjukkan AUC=0,677 (IK 95% 0.557-0,798), p=0,006 dengan titik potong optimal di 63,5 milidetik yang menunjukkan sensitivitas 60% dan spesifisitas 77,8 persen.
Simpulan: Hasil penelitian ini menunjukkan pemanjangan PWPTV1 memiliki nilai diagnostik yang rendah untuk skrining disfungsi diastolik signifikan pada pasien sindrom koroner akut.
Background: Significant diastolic dysfunction (grade 2 and 3) is a relatively common complication and an independent predictor of mortality in acute coronary syndrome (ACS). Evaluation of diastolic function by echocardiography is not always feasible and accessible throughout all levels of healthcare facilities. Electrocardiogram (ECG) test is more readily available and has been shown in previous studies to have a diagnostic value to screen for diastolic dysfunction in hypertensive and chronic kidney disease (CKD) patients.
Objective: The purpose of this study is to examine whether ECG indices P wave peak time (PWPT) and T wave peak to T wave end (Tp-e) can be used as an aid to screen for significant diastolic dysfunction in patients with acute coronary syndrome.
Methods: Secondary data (echocardiogram and ECG on the same day) of 93 ACS patients admitted to the intensive coronary care unit (ICCU) from January 2020 to January 2021 were analyzed in this cross-sectional study. PWPTV1 was defined as the time from begining of P wave to its peak (meassured in lead V1). Tp-e was defined as the time from begining of T wave peak to its end (meassured preferably in lead V5). ECG evaluator was blinded to the echocardiogram results. ECG indices and other variables were compared between groups of ACS patients with and without significant diastolic dysfunction.
Results: Significant diastolic dysfunction was present in 32,3% of ACS patients. PWPTV1 was significantly prolonged in the significant diastolic dysfunction group (65 vs. 59 miliseconds, p<0.01). PWPTV1 has significant correlation with left atrial volume index (LAVI) (r=0,283, p=0,019) and was found to be an independent predictor of significant diastolic dysfunction (OR=1,062, p=0,035). Tp-e on the other hand showed no difference between the two groups and was not correlated with echocardiography diastolic dysfunction indices. Receiver operating characteristics (ROC) analysis of PWPTV1 showed AUC=0,677 (IK 95% 0.557-0,798), p=0,006 with optimal cut off point of 63,5 miliseconds which showed 60% sensitivity and 77,8% specificity.
Conclusion: In this study prolonged PWPTV1 was shown to have low diagnostic value to screen for significant diastolic dysfunction in ACS patients"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Tuti Herawati
Efektivitas model asuhan keperawatan mandiri berkelanjutan pada pasien sindrom koroner akut dan pelaku rawat keluarganya = Effectiveness of the continuous independent nursing care model for acute coronary syndrome patients and their family caregivers
"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."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2021
D-pdf
UI - Disertasi Membership  Universitas Indonesia Library
cover
Nita Aprilia
Analisis Faktor yang Berhubungan dengan Berduka pada Pasien yang Dirawat Pasca Sindrom Koroner Akut (SKA) = Analysis of Factors Associated with Grieving among Hospitalized Patients After Acute Coronary Syndrome (ACS) Event
"Berduka dapat dirasakan oleh pasien SKA yang kehilangan kondisi sehatnya secara tiba-tiba. Berduka bisa menjadi rumit sehingga dapat menurunkan kepatuhan pasien terhadap pengobatan dan meningkatkan resiko kejadian infark berulang dan rehospitalisasi. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan berduka pada pasien yang dirawat pasca SKA. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif analitik, menggunakan pendekatan cross sectional yang melibatkan 132 responden. Analisis data menggunakan analisis deskriptif, uji chi square dan regresi logistik berganda. Karakteristik sosiodemografik responden menunjukkan bahwa sebagian besar berjenis kelamin laki-laki, berpendidikan tinggi, aktif bekerja, dan berstatus menikah. Responden dengan usia ≤ 60 tahun dan > 60 tahun memiliki proporsi yang sama. Berdasarkan karakteristik klinis, sebagian besar responden menjalani rawat inap ≤ 5 hari, tidak memiliki riwayat SKA, memiliki ko-morbid, dan memiliki keterbatasan mobilitas fisik. Sebagian besar responden memiliki dukungan keluarga baik, kecerdasan spiritual baik dan persepsi terhadap penyakit negatif. Hasil dari penelitian ini menunjukkan bahwa sebagian besar responden mengalami berduka yang tinggi. Terdapat hubungan yang signifikan antara ko-morbid (p=0.028), keterbatasan mobilitas fisik (p=0.031), kecerdasan spiritual (p=0.022), dan persepsi terhadap penyakit (p=0.004), dimana persepsi terhadap penyakit adalah faktor yang paling dominan berhubungan dengan berduka, dengan OR 3.362 (CI 95% 1.389-8.134). Pentingnya intervensi keperawatan untuk meningkatkan persepsi terhadap penyakit dan mencegah terjadinya berduka tinggi yang memanjang dan rumit pada pasien SKA.
Grief can occur in ACS patients who suddenly lose their healthy condition. Grieving can be complicated and can reduce patient compliance with treatment and increase the risk of recurrent infarction and rehospitalization. This study aims to determine factors associated with grieving among hospitalized patients after ACS event. This research is a quantitative research with a descriptive analytical design, using cross sectional approach involving 132 respondents. Data analysis used descriptive analysis, chi-square test and multiple logistic regression. The sociodemographic characteristics of the respondents showed that the majority were men, highly educated, actively working, and married. Respondents aged ≤ 60 years and > 60 years have the same proportion. In clinical characteristics, most of the respondents were hospitalized for ≤ 5 days, had no history of ACS, had co-morbidities, and had limited physical mobility. Most respondents had good family support, good spiritual intelligence and negative perceptions of illness. The results of this research show that the majority of respondents experienced high levels of griving. There is a significant relationship between co-morbidity (p= 0.028), limited physical mobility (p=0.031), spiritual intelligence (p=0.022) and perception of illness (p=0.004), where perception of the illness is the most dominant factor related to grief, with OR 3.362 (CI 95% 1.389-8.134). It is important to provide nursing interventions to improve perceptions of illness and prevent prolonged and complicated grief in ACS patients."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2024
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Astuti Giantini
Peran faktor genetik dan epigenetik terkait resistensi klopidogrel terhadap kejadian kardiovaskular mayor pada pasien sindrom koroner akut pasca intervensi koroner perkutan = The role of genetic and epigenetic factors related to clopidogrel resistance in major adverse cardiovascular events on acute coronary syndrome patients after percutaneous coronary intervention
"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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
cover
Rahmad Isnanta
Perbedaan karakteristik angiografi koroner pada pasien sindrom koroner akut usia 45 tahun dengan usia 45 tahun di rumah sakit cipto mangunkusumo jakarta = Comparison of coronary angiography characteristics in acute coronary syndrome patients age 45 years with age 45 years at cipto mangunkusumo hospital jakarta / Rahmad Isnanta
"ABSTRAK
Latar 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
ABSTRACT
Background: 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 examination
Results :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."
2014
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Ahmad Fariz Malvi Zamzam Zein
Pengaruh hiperglikemia admisi terhadap kejadian aritmia selama perawatan pasien sindrom koroner akut = The influence of hyperglycemia at admission on in hospital arrhythmia in patients with acute coronary syndrome
"ABSTRAK
Latar Belakang: Aritmia selama perawatan merupakan komplikasi yang sering
terjadi pada pasien sindrom koroner akut (SKA) sehingga dibutuhkan identifikasi
risiko secara dini.
Tujuan: Mengetahui insidens pasien SKA yang mengalami aritmia selama
perawatan dan mengetahui pengaruh hiperglikemia admisi terhadap kejadian
aritmia selama perawatan pasien SKA.
Metode: Studi kohort retrospektif ini menggunakan rekam medik pasien SKA yang
dirawat di ICCU RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari-31
Desember 2014. Hiperglikemia admisi didefinisikan sebagai kadar gula darah
admisi >140 mg/dL. Kejadian aritmia selama perawatan meliputi aritmia atrium,
takikardia supraventrikular, blok AV derajat tinggi, dan aritmia ventrikel, yang
diidentifikasi dalam tujuh hari pertama perawatan.
Hasil: Terdapat 232 subjek pada penelitian ini. Prevalensi hiperglikemia admisi
adalah 50,43%. Insidens pasien SKA yang mengalami aritmia selama perawatan
adalah 21,55% (IK 95% 16,26-26,84). Analisis bivariat menunjukkan
hiperglikemia admisi terkait dengan peningkatan risiko aritmia selama perawatan
(RR 1,747; IK 95% 1,042-2,930). Tidak terdapat hubungan yang bermakna antara
jenis SKA, diabetes melitus (DM), obesitas, dan hipertensi dengan kejadian aritmia
selama perawatan. Analisis multivariat menunjukkan OR hiperglikemia admisi
setelah penyesuaian adalah 2,852 (IK 95% 1,351-6,024), dengan variabel perancu
DM.
Simpulan: Insidens pasien SKA yang mengalami aritmia selama perawatan adalah
21,55%. Hiperglikemia admisi dapat meningkatkan risiko kejadian aritmia selama perawatan pasien SKA.ABSTRACT Background: The in-hospital arrhythmias complicating acute coronary syndrome
(ACS) is a common complication, and its ealy risk identification is urgently needed.
Aim: to determine the incidence of in-hospital arrhythmia complicating ACS and
to determine the influence of HA on in-hospital arrhythmia complicating ACS.
Methods: a retrospective cohort study was conducted using secondary data from
medical records of patients with ACS who were admitted to ICCU RSCM between
January 1st-Desember 31st, 2014. Hyperglycemia at admission was defined when
the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias
were observed during the first seven days of hospitalization.
Result: there were 232 subjects. The prevalence of HA WAS 50.43%. The
incidence of in-hospital arrhythmias was 21.55% (95% CI 16.26-26.84). In
bivariate analysis, there was significant association between HA and in-hospital
arrhythmia (RR 1.747; 95% CI 1.042-2.930). There were no significant relationship
among the type of ACS, diabetes mellitus (DM), obesity, and hypertension, with
the influence of HA on in-hospital arrhythmia. In multivariate analysis, the adjusted
OR of HA was 2.852 (95% CI 1.351-6.024), and DM was the confounding variable.
Conclusion: In-hospital arrhythmias is a common complication in patients with
ACS. Hyperglycemia at admission may increase the risk of in-hospital arrhythmia complicating ACS. ;Background: The in-hospital arrhythmias complicating acute coronary syndrome
(ACS) is a common complication, and its ealy risk identification is urgently needed.
Aim: to determine the incidence of in-hospital arrhythmia complicating ACS and
to determine the influence of HA on in-hospital arrhythmia complicating ACS.
Methods: a retrospective cohort study was conducted using secondary data from
medical records of patients with ACS who were admitted to ICCU RSCM between
January 1st-Desember 31st, 2014. Hyperglycemia at admission was defined when
the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias
were observed during the first seven days of hospitalization.
Result: there were 232 subjects. The prevalence of HA WAS 50.43%. The
incidence of in-hospital arrhythmias was 21.55% (95% CI 16.26-26.84). In
bivariate analysis, there was significant association between HA and in-hospital
arrhythmia (RR 1.747; 95% CI 1.042-2.930). There were no significant relationship
among the type of ACS, diabetes mellitus (DM), obesity, and hypertension, with
the influence of HA on in-hospital arrhythmia. In multivariate analysis, the adjusted
OR of HA was 2.852 (95% CI 1.351-6.024), and DM was the confounding variable.
Conclusion: In-hospital arrhythmias is a common complication in patients with
ACS. Hyperglycemia at admission may increase the risk of in-hospital arrhythmia complicating ACS. "
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Randy Elbert
Faktor-Faktor yang Berhubungan dengan Kejadian Penyakit Kardiovaskular pada Penduduk Usia Produktif di Daerah Istimewa Yogyakarta (Analisis Data Riskesdas 2018) = Factors Associated with Cardiovascular Disease in Productive Age Population in Special Region of Yogyakarta (Data Analysis of Riskesdas 2018)
"

Penyakit kardiovaskular juga merupakan penyebab utama kematian secara global. Di Indonesia, penyakit kardiovaskular mengalami peningkatan prevalensi setiap tahunnya dan menempati peringkat tertinggi sebagai penyebab kematian terutama pada usia produktif. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian penyakit kardiovaskular pada penduduk usia produktif di Daerah Istimewa Yogyakarta berdasarkan data Riset Kesehatan Dasar 2018. Desain studi penelitian ini adalah cross-sectional dengan analisis bivariat. Hasil penelitian menunjukan prevalensi penyakit kardiovaskular pada penduduk usia produktif di Provinsi DI Yogyakarta pada tahun 2018 adalah sebesar 2,7%. Faktor yang berhubungan secaara statistik dengan kejadian penyakit kardiovaskular yaitu umur (POR = 4,615; 95% CI: 3,489-6,104), jenis kelamin (POR = 0,751; 95% CI: 0,566-0,995), tingkat pendidikan (POR = 1,405; 95% CI: 1,064 – 1,855), hipertensi (nilai POR = 2,391; 95% CI: 1,810-3,158), diabetes melitus (POR = 8,531; 95% CI: 5,899 – 12,337), status merokok (POR = 1,979; 95% CI: 1,327-2,950; dan POR = 2,794; 95% CI: 1,738-4,492), obesitas (POR = 1,630; 95% CI: 1,206 - 2,204), aktivitas fisik (POR = 1,968; 95% CI: 1,292 – 2,999), gangguan mental emosional (POR = 2,344; 95% CI: 1,661 – 3,307), konsumsi makanan asin (POR = 0,693; 95% CI: 0,519 – 0,927), dan konsumsi makanan lemak/kolesterol/gorengan (POR = 0,698; 95% CI: 0,517 – 0,944). Sementara itu, konsumsi buah dan sayur serta konsumsi alkohol tidak berhubungan secara statistik dengan kejadian penyakit kardiovaskular. Optimalisasi program pengendalian PTM seperti CERDIK dapat membantu pencegahan kejadian penyakit kardiovaskular.

Cardiovascular disease is the leading cause of death globally. In Indonesia, cardiovascular disease has an increasing prevalence every year and ranks highest as a cause of death, especially in productive age. This study aims to determine the factors associated with the incidence of cardiovascular disease in the productive age population in the Special Region of Yogyakarta based on data from the 2018 Basic Health Research. The design of this research study was cross-sectional with bivariate analysis. The results showed that the prevalence of cardiovascular disease in the productive age population in Yogyakarta Province in 2018 was 2.7%. Statistically related factors to cardiovascular disease incidence were age (POR = 4.615; 95% CI: 3.489-6.104), sex (POR = 0.751; 95% CI: 0.566-0.995), education level (POR = 1.405; 95% CI: 1.064 – 1.855), hypertension (POR value = 2.391; 95% CI: 1.810-3.158), diabetes mellitus (POR = 8.531; 95% CI: 5.899 – 12.337), smoking status (POR = 1.979; 95% CI: 1.327-2.950; and POR = 2.794; 95% CI:  1.738-4.492), obesity (POR = 1.630; 95% CI: 1.206 - 2.204), physical activity (POR = 1.968; 95% CI: 1.292 – 2.999), mental emotional disorders (POR = 2.344; 95% CI: 1.661 – 3.307), consumption of salty foods (POR = 0.693; 95% CI: 0.519 – 0.927), and consumption of fat/cholesterol/fried foods (POR = 0.698; 95% CI: 0.517 – 0.944). Meanwhile, fruit and vegetable consumption and alcohol consumption were not statistically associated with the incidence of cardiovascular disease. Optimization of NCD control programs such as CERDIK can help prevent cardiovascular disease events

"
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2023
S-pdf
UI - Skripsi Membership  Universitas Indonesia Library
cover
Bhanu
Peran skor modified ACEF dalam memprediksi kompleksitas lesi koroner pada pasien penyakit ginjal kronik stadium 3 dan 4 dengan sindrom koroner akut = Role of modified ACEF score in predicting severity of coronary lesions in patients with chronic kidney disease stages 3 and 4 with acute coronary syndrome
"ABSTRAK
Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat
tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanya
lebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuah
perangkat yang memiliki peran penting dalam prognosis mortalitas PJK. Skor
mACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.
Informasi tersebut berguna dalam menentukan prioritas tindakan angiografi
koroner.
Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagai
prediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yang
mengalami sindrom koroner akut (SKA).
Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179
subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCM
tahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan dengan
menggunakan Receiver Operating Characteristic (ROC) curves dengan interval
kepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengan
cara menghitung sensitivitas, spesifisitas, RKP, dan RKN.
Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas
90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%.
Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGK
stadium 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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."
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
<<   1 2 3 4 5 6 7 8 9 10   >>