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"ABSTRAKLatar Belakang: Lesi koroner kompleks berkaitan dengan prognosis buruk SKA. Pentingnya revaskularisasi awal untuk mengurangi angka morbiditas dan mortalitas. PLR berkaitan dengan kompleksitas lesi buruk dan diharapkan menjadi acuan dalam identifikasi dini lesi koroner kompleks.Tujuan: Mengetahui akurasi diagnostik dan nilai titik potong PLR sebagai penapis lesi koroner kompleks baik pada kelompok usia ≤45 tahun dan >45 tahun.Metode: Sebuah studi potong lintang secara retrospektif di ICCU RSUPN-CM. Data diambil dari rekam medis pasien SKA dewasa dan menjalani angiografi koroner dari Januari 2012 ? Juli 2015. Akurasi diagnositik dinilai dengan menghitung sensitivitas dan spesifisitas. Nilai titik potong ditentukan menggunakan kurva ROC.Hasil: Proporsi pasien SKA dengan lesi koroner kompleks 47,2%. Nilai titik potong optimal pada pasien usia ≤45 tahun adalah 111,06 dengan sensivitas 91,3% dan spesifisitas 91,9. Pada kelompok usia >45 tahun nilai titik potong optimal pada angka 104,78 dengan nilai sensivitas 91,7% dan spesifisitas 58,6.Simpulan: Nilai titik potong PLR optimal pada kelompok usia ≤45 adalah 111,06 dan kelompok usia >45 tahun adalah 104,78 dengan akurasi diagnositik masing-masing AUC 93,9% (p <0,001) dan AUC 77,3% (p <0,001).

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ABSTRACT

Background: A Complex coronary lesion is related to poor prognosis in ACS patient. The importance of early revascularization is to decrease mortality and complications. Inflammatory marker such as PLR related to complex coronary lesions and expected to be a tool that can assist physicians and cardiologists to stratify patients who have high probability for having a complex coronary lesion.

Aim: Evaluate the diagnostic accuracy of PLR in identifying a complex coronary lesion in ACS patient. The other aim was to identify the proportion of complex coronary lesion and cut-off point of PLR between ≤45 years old group and >45 years old group subjects.

Method: This is a cross sectional retrospectively study in ACS patients hospitalized in ICCU of RSUPN-CM from January 2012 until July 2015. The inclusion are adult ACS patients and who underwent coronary. The diagnostic accuracy was determined by calculating the sensitivity, specificity, PPV, NPV, Positive LR, and Negative LR. The cut-off point was determined using ROC curve.

Results: The proportion of complex coronary lesion was 47,2%. The optimal cut-off point in ≤45 years old group was 111,06 with sensitivity and specificity respectively 91,3% and 91,9%. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity and specificity respectively 91,7% and 58,6%.

Conclusion: The optimal cut-off point of ≤45 years old groups is 111,06 and for >45 years old group is 104,78. The diagnostic accuracy of PLR in ≤45 years old groups was very good (AUC 93,9%, p value <0,001), while in >45 years old group was moderate (AUC 77,3%, p value <0,001)."

"ABSTRAK Latar Belakang: Perlunya stratifikasi risiko dan evaluasi terapi berkala pada sindrom koroner akut (SKA) terkait mortalitas dan morbiditas di kemudian hari.Petanda biokimia ST2 praktis dan lebih murah, serta tidak dipengaruhi oleh usia,jenis kelamin dan fungsi ginjal. Kadarnya dapat berbeda antar ras, namun belumada data yang menyajikan profil kadar ST2 awal dan penurunan pasca terapidefinitif di Indonesia. Metode: Studi deskriptif longitudinal pada 40 subjek yang diperiksan kadar ST2secara ELISA saat awal dan setelah terapi definitif. Hasil: Didapatkan proporsi kadar ST2 awal <35 ng/mL lebih dominan ( 52,5% vs.47,5%). Kadar ST2 awal tertinggi didapatkan pada IMA-NST, yaitu 46,79 ng/mL(kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) yang memiliki awitan terlama(48 jam). Hipertensi memiliki proporsi tertinggi (91,7%) dan usia berbanding lurusdengan kadar ST2. Proporsi kadar ST2 yang tidak mengalami penurunan sebesar30%, terutama APTS (41,7%) dengan usia rerata 3 tahun lebih tua (58 tahun vs. 55tahun).Simpulan: Didapatkan kadar ST2 <35 ng/mL pada sebagian besar subjek, tertinggipada IMA-NST. Lama awitan, hipertensi dan usia diduga berhubungan dengankadar ST2 awal tinggi. Kadar ST2 pasca terapi menurun pada sebagian besar subjek.ABSTRACT Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. Anew biomarker ST2 is practice and less expensive for daily usage and it also doesn?tinfluenced by age, gender, and kidney function. The ST2 value are different in dueto race among countires. There is no data available regarding ST2 baseline and afterdefinitive treatment profile in Indonesia.Method: It is a longitudinal descriptive study that conducted prospectively on 40subjects. The value of ST2 was examined using ELISA methods at baseline andafter definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had thelongest onset of chest pain (48 hours). Hypertension had the highest proporsion(91,7%) and age were proportional to the ST2 value. The proportion of the ST2value that didn?t decreased after therapy were lesser than the decrease (30% vs.70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 yearsold).Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higherthan ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 levelwere found in NSTEMI-ACS. Onset of angina, hypertension and age were foundto be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. Anew biomarker ST2 is practice and less expensive for daily usage and it also doesn?tinfluenced by age, gender, and kidney function. The ST2 value are different in dueto race among countires. There is no data available regarding ST2 baseline and afterdefinitive treatment profile in Indonesia.Method: It is a longitudinal descriptive study that conducted prospectively on 40subjects. The value of ST2 was examined using ELISA methods at baseline andafter definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had thelongest onset of chest pain (48 hours). Hypertension had the highest proporsion(91,7%) and age were proportional to the ST2 value. The proportion of the ST2value that didn?t decreased after therapy were lesser than the decrease (30% vs.70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 yearsold).Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higherthan ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 levelwere found in NSTEMI-ACS. Onset of angina, hypertension and age were foundto be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. Anew biomarker ST2 is practice and less expensive for daily usage and it also doesn?tinfluenced by age, gender, and kidney function. The ST2 value are different in dueto race among countires. There is no data available regarding ST2 baseline and afterdefinitive treatment profile in Indonesia.Method: It is a longitudinal descriptive study that conducted prospectively on 40subjects. The value of ST2 was examined using ELISA methods at baseline andafter definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had thelongest onset of chest pain (48 hours). Hypertension had the highest proporsion(91,7%) and age were proportional to the ST2 value. The proportion of the ST2value that didn?t decreased after therapy were lesser than the decrease (30% vs.70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 yearsold).Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higherthan ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 levelwere found in NSTEMI-ACS. Onset of angina, hypertension and age were foundto be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. Anew biomarker ST2 is practice and less expensive for daily usage and it also doesn?tinfluenced by age, gender, and kidney function. The ST2 value are different in dueto race among countires. There is no data available regarding ST2 baseline and afterdefinitive treatment profile in Indonesia.Method: It is a longitudinal descriptive study that conducted prospectively on 40subjects. The value of ST2 was examined using ELISA methods at baseline andafter definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had thelongest onset of chest pain (48 hours). Hypertension had the highest proporsion(91,7%) and age were proportional to the ST2 value. The proportion of the ST2value that didn?t decreased after therapy were lesser than the decrease (30% vs.70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 yearsold).Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higherthan ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 levelwere found in NSTEMI-ACS. Onset of angina, hypertension and age were foundto be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. "

"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."

"Sindrom koroner akut (SKA) merupakan masalah utama penyakit jantung yang merupakan penyebab kematian tertinggi setelah stroke di Indonesia. SKA dapat dinilai keparahannya melalui skor Gensini dan prognosisnya melalui kejadian Major Adverse Cardiac Event (MACE). High Sensitive Troponin T (hsTroponin T) adalah biomarker yang direkomendasikan beberapa badan internasional dalam mendiagnosis infark miokard. Pada pasien SKA yang disertai penyakit ginjal kronik (PGK) akan mempengaruhi hasil pemeriksaan hsTroponin T. Hal ini disebabkan oleh kadar ureum darah yang tinggi bersifat toksik dan kondisi PGK menurunkan fungsi ginjal sehingga mempengaruhi kadar hsTroponin T. Penelitian ini bertujuan mengetahui hubungan hstroponin T dan ureum dengan skor Gensini, MACE jangka pendek pada pasien SKA yang disertai PGK di RSUPN dr. Cipto Mangunkusumo. Metode penelitian adalah potong lintang dilakukan pada bulan Januari-Oktober 2018. Subjek penelitian meliputi seluruh pasien yang mengikuti penelitian terdahulu “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”. Kadar hsTroponin T dan ureum subjek SKA dengan PGK dihubungkan dengan skor Gensini dan kejadian MACE jangka pendek. Terdapat 80 subjek SKA dengan PGK, terdiri dari 63 subjek STEMI -NSTEMI dengan peningkatan hsTroponin T dan 17 subjek UAP. Terdapat 34 subjek mengalami MACE diantaranya ada 11 subjek yang meninggal. Tidak terdapat korelasi kadar hsTroponin T dengan skor Gensini, r = 0,095, p=0,401 dan juga ureum dengan skor Gensini, r = 0,107, p = 0,343. Peningkatan kadar hsTroponin T memberikan peningkatan Odds Ratio (OR) sebesar 1,59 dan ureum OR 3,14 dengan p<0,05 terhadap kejadian MACE jangka pendek. Titik potong hsTroponin T terhadap kejadian MACE jangka pendek sebesar 150,5ng/L dengan sensitivitas 53,5%, spesifisitas 55,3%, nilai prediksi positif (NPP) 48%, nilai prediksi negatif (NPN) 63,33%. Titik potong ureum terhadap kejadian MACE jangka pendek 47,45mg/dL dengan sensitivitas 52,9%, spesifisitas 47,8%, NPP 63,63%, NPN 63,79%. Berdasarkan hasil tersebut peningkatan kadar hsTroponin T diatas 150,5ng/L dan ureum47,45mg/dL berperan dalam meningkatkan risiko kejadian terjadinya MACE jangka pendek dengan OR 1,59 dan 3,14 pada pasien SKA dengan PGK. Gambaran kadar hsTroponin T bervariasi pada setiap stadium PGK tetapi ada kecenderungan peningkatan kadar seiring dengan peningkatan stadium PGK, untuk itu diperlukan penelitian lebih lanjut untuk mendapatkan gambaran kadar hsTroponin T yang lebih jelas.

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Acute Coronary Syndrome(ACS) is the main problem in heart disease which is the highest mortality after stroke in Indonesia. ACS can be assess the severity degree by Gensini scoring and its prognosis by Major Adverse Cardiac Event (MACE). High sensitive Troponin T (hsTroponin T) is biomarker that recomended by several international associations in diagnosing miocard infarct. Level of hs Troponin T can be affected in patients with ACS and chronic kidney disease (CKD), because lower filtration in CKD and high level ureum has toxic effect.This research aimed in knowing the relation of hsTroponin T and ureum with Gensini score, short term MACE, in ACS and CKD in RSUPN dr. Cipto Mangunkusumo. Methods using cross sectional in January-October 2018. All patients in elder research “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”, are included in this research, and then search for the correlation between hsTroponin T, ureum and Gensini score, short term MACE. There are 80 subjects ACS with CKD, 63 subjects with STEMI -NSTEMI (ST Elevation Miocard Infarct-Non ST Elevation Miocard Infarct) and elevated level of hs-troponin T, 17 subjects UAP (Unstable Angina Pectoris), 34 subjects MACE and 11 subjects within were died. There is no correlation between hsTroponin T and Gensini score is not , r=0,095 with p=0,401. There is no correlation between ureum and Gensini score r= 0,107 with p=0,343. Level of hsTroponin T and ureum has odds ratio OR= 1,59 and 3,14, p<0,05 towards short term MACE. The cut off for hsTroponin T towards short term MACE is 150,5ng/L with sensitivity 53,5%, specificity 55,3%, positive predictive value (PPV) 48%, negative predictive value (NPV) 63,33%. The cut off for ureum towards short term MACE is 47,45mg/dL with sensitivity 52,9%, specificity 47,8%, PPV 63,63%,NPV 63,79%. The descriptions of hsTroponin T level are various in every stage of CKD. According to that results, ascending level in hsTroponin T with cut off 150,5ng/L and ureum 47,45mg/dL has an impact in short term MACE (OR hsTroponin T=1,59 and ureum=3,14) in patients with ACS and CKD. The descriptions of level hsTroponin T are variety, but have tendency to escalate level hsTroponin T in every stage of CKD and need advance research to have clear descriptions."

"ABSTRAKAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly, diabetics, and patients with prior stroke or heart failure.1 Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality.2 Abstract : Acute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 yearsold male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST-Elevation Myocardial In- farction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (ACS) work-up are obligatory to prevent delayed diagnosis and management. "

"ABSTRACTAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 years old male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST Elevation Myocardial Infarction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (AC5) work up are obligatory to prevent delayed diagnosis and management."

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

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

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

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

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

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

"Nyeri punggung atas adalah salah satu gejala atipikal dari infark miokard akut (IMA) yang lebih sering ditemukan pada perempuan, lanjut usia dan penderita diabetes. Kegagalan untuk mengenali presentasi atipik dari IMA menyebabkan telatnya diagnosis yang dihubungkan dengan meningkatnya mortalitas dan morbiditas. Dalam kasus ini kami melaporkan seorang laki-laki berusia 46 tahun datang dengan keluhan nyeri punggung atas yang berat dan mendadak sejak 6 jam sebelum masuk rumah sakit. Diagnosis IMA tertunda hingga 12 jam kemudian ketika nyeri dada tipikal dirasakan dan EKG menunjukan evolusi dari STEMI. Karena presentasi klinis yang atipikal, diagnosis IMA pada pasien ini tertunda. Pemantauan yang jeli dan pemeriksaan lanjutan untuk sindrom koroner akut (SKA) wajib dilaksanakan untuk mencegah tertundanya diagnosis dan tata laksana yang sesuai."

"Penyakit jantung koroner merupakan masalah kardiovaskuler utama yang menyebabkan angka perawatan rumah sakit dan kematian di dunia. Infark miokard merupakan penyakit jantung koroner yang terjadi secara spontan akibat trombosis koroner, kerusakan arteri koroner, erosi plak aterosklerosis, ketidakseimbangan suplai dan kebutuhan oksigen. Tujuan penelitian ini adalah untuk mengetahui hubungan antara indeks respon gejala ACS dan persepsi penyakit selama dirawat dengan kualiats hidup pasca rawat infark miokard. Penelitian ini menggunakan desain non eksperimental jenis cross sectional analitik dengan jumlah sampel 101 orang yang dilakukan di RSI Sakinah Mojokerto. Hasil penelitian menunjukkan terdapat hubungan yang signifikan antara kualitas hidup dengan indeks respon gejala ACS dan persepsi penyakit, usia, status pernikahan, tingkat pendidikan, kecemasan, depresi, dan dukungan sosial p value=0,001

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Coronary heart disease is a major cardiovascular problem that causes hospitalization and mortality rates in the world. Myocardial infarction is a spontaneous coronary heart disease caused by coronary thrombosis, coronary artery damage, atherosclerotic plaque erosion, oxygen supply and demand imbalance. The purpose was to determine the relationship between response index symptom of ACS and illness perception with quality of life after care of myocardial infarction. This research used a non experimental design cross sectional analytic type with a sample of 101 people conducted at Sakinah Hospital in Mojokerto. The results showed a significant relationship between quality of life with response index symptom of ACS, illness perception, marital status, education level, anxiety, depression, and social support p value 0,001"