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"Aplikasi mHealth memiliki potensi menurunkan angka rekurensi sindrom koroner akut. Tujuan penelitian ini adalah mengetahui efektivitas ekonomi layanan standar disertai monitoring menggunakan aplikasi HARKIT iCARE dibandingkan layanan standar pada prevensi sekunder paska sindrom koroner akut. Penelitian ini berbentuk uji klinis acak tersamar dengan perspektif sosietal yang melibatkan 106 pasien paska sindrom koroner akut yang dirawat di Pusat Jantung Nasional Harapan Kita dari bulan Juni sampai Desember 2022. Randomisasi menggunakan permutasi blok acak dengan tindak lanjut selama enam bulan. Utilitas kesehatan dinilai menggunakan kuesioner EQ-5D-5L yang dikonversi menjadi quality adjusted life years. Luaran penelitian berupa incremental cost effectiveness ratio. Permodelan Markov sederhana dengan jangka waktu lima tahun dan siklus 30 hari dilanjutkan analisis bootstrapping 10.000 kali simulasi menunjukkan quality adjusted life yearslebih tinggi pada kelompok HARKIT iCARE (3,23 vs 3,06) namun total biaya yang lebih tinggi (Rp 5.495.920.454 vs Rp 5.041.510.027). Incremental cost effectiveness ratio per quality adjusted life years sebesar Rp 2.673.002.511 melebihi ambang batas kesediaan untuk membayar Indonesia yaitu Rp 225.000.000. Tidak terdapat perbedaan yang bermakna pada kematian segala sebab dan kejadian kardiovaskular mayor. Layanan standar disertai monitoring aplikasi HARKIT iCARE tidak bersifat efektif secara biaya jika dibandingkan dengan layanan standar pada prevensi sekunder paska SKA.

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mHealth application has a potential to improve acute coronary syndrome recurrency. The objective of this study was to determine the economic effectiveness of HARKIT iCARE compared to standard secondary prevention in acute coronary syndrome. This study was an economic evaluation alongside randomized clinical trial with societal perspective. A total of 106 hospitalized acute coronary syndrome patients from June to December 2022 in National Cardiovascular Center Harapan Kita were randomized using permuted block method. Base case trial follow-up period was six months. Health utility values were assessed using EQ-5D-5L questionnaire and then converted into quality adjusted life years. Study outcomes were incremental cost effectiveness ratio. A simple Markov model was constructed with time horizon of five years and 30 days cycle. Bootstrapping analysis with 10,000 simulation showed quality adjusted life years was higher in HARKIT iCARE group (3,23 vs 3,06) but higher total cost (Rp 5.495.920.454 vs Rp 5.041.510.027). Incremental cost effectiveness ratio per quality adjusted life years was Rp 2.673.002.511, exceeding the willingness to pay threshold based on three times of Indonesia gross domestic product per capita in 2023 Rp 225.000.000. There was no difference in all-cause mortality and major adverse cardiovascular event. HARKIT iCARE as addition to standard secondary prevention was not cost effective compared to standard care in post acute coronary syndrome patients."

"Latar Belakang : Aplikasi mHealth menjadi modalitas menjanjikan dalam prevensi sekunder sindrom koroner akut. Tujuan dari studi ini adalah untuk mengetahui pengaruh aplikasi mHealth HARKIT iCare terhadap angka rehospitalisasi dan kepatuhan minum obat.Tujuan : Mengetahui efek penggunaan aplikasi HARKIT iCare dibandingkan dengan layanan standar terhadap angka rehospitalisasi dan kepatuhan minum obat.Metode : Studi ini adalah uji klinis acak tunggal,106 subyek pasien pasca-sindrom koroner akut dirandomisasi dengan permutasi blok acak ke kelompok aplikasi berbasis aplikasi ponsel pintar HARKIT iCare atau layanan standar. Subyek diikuti selama 6 bulan lalu dilihat angka rehospitalisasi dan kepatuhan minum obat menggunakan MMAS-8 sebagai parameter luaran.Hasil : Rehospitalisasi berulang lebih rendah pada kelompok iCare dibandingkan kontrol setelah dilakukan analisis multivariat (2 [3.7%] vs 7 [13.5%], HR 0.11 [IK 95% 0.01-0.98], p=.048). Rehospitalisasi tak terencana lebih rendah pada kelompok iCare dibanding kontrol, tidak berbeda bermakna (13 [24.1%] vs 16 [30.8%], HR 0.73 [IK 95% 0.35-1.53], p=.41). HARKIT iCare berkorelasi pada peningkatan tingkat kepatuhan secara signifikan setelah dilakukan analisis multivariat (16 [30.8%] vs 26 [48.1%], RR 2.37 [IK 95% 1.00-5.61], p=.049). Terdapat peningkatan bermakna secara statistik perbedaan nilai median kepatuhan minum obat berdasarkan MMAS awal dan akhir pada kelompok iCare dibandingkan kontrol (iCare - MMAS awal 6.5 [2-8] akhir 8 [4-8] Δ median = +1.5, p=.000 ; kontrol - MMAS awal 7 [3-8], akhir 8 [5-8], Δ median = +1, p=0.053 ).Kesimpulan Penggunaan aplikasi HARKIT iCare berkorelasi dengan angka rehospitalisasi berulang yang lebih rendah dan peningkatan derajat kepatuhan minum obat diukur dengan peningkatan median MMAS.

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Background Smartphone based mHealth applications is a promising platform for increase adherence to secondary prevention programs post acute coronary syndrome. The aim of this study is to know the impact of smartphone based mHealth applications HARKIT iCare on rehospitalization and medication adherence.

Objective To determine the impact of HARKIT iCare apps on secondary prevention compared to standard care on rehospitalization and medication adherence.

Method Study was a single blinded randomized clinical trial involving 106 subjects post-acute coronary syndrome. Subjects were randomized by permuted block randomization into HARKIT iCare (intervention) group or standard care. Subjects were followed for 6 months. The outcome of this study was rates of unplanned and recurrent rehospitalization, and also medication adherence by questionnare MMAS-8.

Result Recurrent hospitalization occurred fewer in the iCare group compared to control (Adjusted, 2 [3.7%] vs 7 [13.5%], HR 0.11 [CI 95% 0.01-0.98], p=.048). Unplanned rehospitalization also occured fewer in iCare group compared to control, significantly different (13 [24.1%] vs 16 [30.8%], HR 0.73 [CI 95% 0.35-1.53], p=.41). HARKIT iCare related to increased levels of adherence (Adjusted, 16 [30.8%] vs 26 [48.1%], RR 2.34 [CI 95% 1.03-5.33], p=.049). Comparison between pre and post median MMAS was significant for iCare group but not with control group. (iCare - MMAS pre 6.5 [2-8] post 8 [4-8] Δ median = +1.5, p=.000 ; control - MMAS pre 7 [3-8], post 8 [5-8], Δ median = +1, p=.053).

Conclusion HARKIT iCare related with fewer recurrent rehospitalization, increase of medication adherence and improvement of median MMAS significantly."

"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.

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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."

"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.

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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."

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

"Sindrom koroner akut (SKA) merupakan masalah kesehatan nasional karena tingginya angka morbiditas dan mortalitas serta beban biaya yang dibutuhkan. Intervensi koroner perkutan (IKP) dan terapi antiplatelet seperti klopidogrel merupakan tata laksana yang direkomendasikan oleh organisasi kardiologi internasional. Meskipun demikian, pasien SKA masih dapat mengalami kejadian kardiovaskular mayor (KKM). Kemungkinan, resistensi klopidogrel berperan pada KKM sedangkan resistensi klopidogrel mungkin dipengaruhi oleh faktor genetik dan epigenetik. Penelitian ini bertujuan untuk mengetahui hubungan faktor genetik yaitu polimorfisme gen CYP2C19 dan P2Y12, serta epigenetik yaitu metilasi DNA gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dengan resistensi klopidogrel dan pengaruhnya terhadap KKM pada pasien SKA pasca IKP.Untuk menganalisis hubungan faktor genetik dan epigenetik dengan resistensi klopidogrel, penelitian dilakukan dengan desain potong lintang, sedangkan untuk analisis hubungan faktor genetik dan epigenetik dengan KKM dilakukan dengan desain kohort prospektif. Subjek penelitian meliputi 201 pasien SKA pasca IKP dan mendapat terapi klopidogrel di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2018 sampai dengan Juni 2020. Resistensi klopidogrel ditentukan dengan pemeriksaan light transmission aggregometry (LTA) apabila hasilnya lebih besar dari 59% dengan agonis ADP 20 mM. Deteksi polimorfisme gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dilakukan dengan metode qRT-PCR, sedangkan metilasi DNA gen CYP2C19 dan P2Y12 dikerjakan dengan metode konversi bisulfit. Pasien diobservasi selama satu tahun dan jika ada angina pektoris, infark miokard akut (IMA) rekuren, stroke, atau kematian, dicatat sebagai KKM.Dari 201 subjek, terdapat 45,8% carrier mutant polimorfisme *2 dan *3 gen CYP2C19, 36,8% carrier mutant polimorfisme rs3679479 gen P2Y12, 10% hipometilasi DNA gen P2Y12, 80,1% hipometilasi DNA gen CYP2C19, dan 66,2% ekspresi miRNA-26a up regulated. Proporsi resisten klopidogrel adalah 49,8% dan proporsi KKM adalah 14,9% (kematian 7,5%). Terdapat hubungan antara merokok (p = 0,001; OR 0,37 [IK 95%; 0,20–0,68]), hipometilasi DNA gen CYP2C19 (p = 0,037; OR 2,13 [IK 95%; 1,04–4,37]), dan ekspresi miRNA-26a up regulated (p = 0,020; OR 2,03 [IK 95%; 1,12–3,68]) dengan resistensi klopidogrel. Terdapat hubungan antara jenis kelamin perempuan (p = 0,040; HR 2,73 [IK 95%; 1,05–7,14]), usia ≥ 60 tahun (p = 0,035; HR 2,17 [IK 95%; 1,06–4,48]), eGFR rendah (p = 0,001; HR 3,29 [IK 95%; 1,59–6,84]), dan polimorfisme *2 dan *3 gen CYP2C19 (p = 0,047; HR 2,12 [IK 95%; 1,01–4,46]) dengan KKM dalam satu tahun.Hanya faktor epigenetik berupa metilasi DNA gen CYP2C19 dan ekspresi miRNA-26a yang berhubungan dengan resistensi klopidogrel. Walaupun resistensi klopidogrel tidak berhubungan dengan KKM, terdapat hubungan antara faktor genetik polimorfisme *2 dan *3 gen CYP2C19 dengan KKM.

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Acute coronary syndrome (ACS) is a national health problem due to high morbidity and mortality, and cost burden as well. Percutaneous coronary intervention (PCI) and antiplatelet therapy such as clopidogrel are recommended. However, ACS patients could still experience major adverse cardiovascular events (MACE). Clopidogrel resistance possibly plays a role in MACE whereas it may be affected by genetic and epigenetic factors. Therefore, the objective of this study was to determine the relationship between genetic factors which are CYP2C19 and P2Y12 polymorphisms, as well as epigenetic factors which are DNA methylation of CYP2C19 and P2Y12, and miRNA-26a expression and their effects on MACE in post-PCI patients.

To analyze the association between genetic and epigenetic factors and clopidogrel resistance, the study design was cross-sectional, while the study design of relationship between genetic and epigenetic factors and MACE was prospective cohort. The subjects were 201 post-PCI ACS patients who received clopidogrel therapy at Harapan Kita Hospital from September 2018 to June 2020. Clopidogrel resistance was determined by light transmission aggregometry (LTA) if the result was greater than 59% with agonist ADP 20 µM. The detection of CYP2C19 and P2Y12 gene polymorphisms and miRNA-26a expression were carried out by qRT-PCR method, while the DNA methylation of the CYP2C19 and P2Y12 genes were carried out by bisulfite conversion method. Patients were observed for one year and angina pectoris, recurrent acute myocardial infarction (AMI), stroke, or death, were recorded as MACE.

From 201 subjects, 45.8% were CYP2C19*2 and CYP2C19*3 polymorphism mutant carrier, 36.8% were rs3679479 P2Y12 polymorphism mutant carrier, 10% were hypomethylated of P2Y12, 80.1% were hypomethylated of CYP2C19, and 66.2% were up regulated in miRNA-26a expression. 49.8% of subjects were clopidogrel resistant and 14.9% of subjects experienced MACE (death was 7.5%). Smoking (p = 0.001; OR 0.37 [CI 95%; 0.20–0.68]), hypomethylated of CYP2C19 (p = 0.037; OR 2.13 [CI 95%; 1.04–4.37]), and up regulated miRNA-26a expression (p = 0.020; OR 2.03 [CI 95%; 1.12–3.68]) were associated with clopidogrel resistance. Female gender (p = 0.040; HR 2.73 [CI 95%; 1.05–7.14]), age over 60 years old (p = 0.035; HR 2.17 [CI 95%; 1.06–4.48]), low eGFR (p = 0.001; HR 3.29 [CI 95%; 1.59–6.84]), and CYP2C19*2 and CYP2C19*3 polymorphisms (p = 0.047; HR 2.12 [CI 95%; 1.01–4.46]) were associated with MACE in one year.

Only DNA methylation of CYP2C19 and miRNA-26a expression were associated with clopidogrel resistance. Although clopidogrel resistance was not associated with MACE, there was association between CYP2C19*2 and CYP2C19*3 polymorphisms and MACE."

"ABSTRAK Latar Belakang: Aritmia selama perawatan merupakan komplikasi yang sering terjadi pada pasien sindrom koroner akut (SKA) sehingga dibutuhkan identifikasirisiko secara dini. Tujuan: Mengetahui insidens pasien SKA yang mengalami aritmia selamaperawatan dan mengetahui pengaruh hiperglikemia admisi terhadap kejadianaritmia selama perawatan pasien SKA. Metode: Studi kohort retrospektif ini menggunakan rekam medik pasien SKA yangdirawat di ICCU RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari-31Desember 2014. Hiperglikemia admisi didefinisikan sebagai kadar gula darahadmisi >140 mg/dL. Kejadian aritmia selama perawatan meliputi aritmia atrium,takikardia supraventrikular, blok AV derajat tinggi, dan aritmia ventrikel, yangdiidentifikasi dalam tujuh hari pertama perawatan. Hasil: Terdapat 232 subjek pada penelitian ini. Prevalensi hiperglikemia admisiadalah 50,43%. Insidens pasien SKA yang mengalami aritmia selama perawatanadalah 21,55% (IK 95% 16,26-26,84). Analisis bivariat menunjukkanhiperglikemia admisi terkait dengan peningkatan risiko aritmia selama perawatan(RR 1,747; IK 95% 1,042-2,930). Tidak terdapat hubungan yang bermakna antarajenis SKA, diabetes melitus (DM), obesitas, dan hipertensi dengan kejadian aritmiaselama perawatan. Analisis multivariat menunjukkan OR hiperglikemia admisisetelah penyesuaian adalah 2,852 (IK 95% 1,351-6,024), dengan variabel perancuDM. Simpulan: Insidens pasien SKA yang mengalami aritmia selama perawatan adalah21,55%. 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. "