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Abstrak :
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.

Abstrak :
Rasio Netrofil-Limfosit (RNL) adalah pemeriksaan laboratorium murah dan mudah didapatkan dimanapun, dan saat ini berkembang menjadi penanda luaran pada berbagai kondisi, termasuk pada Sindrom Koroner Akut (SKA). RNL menggabungkan dua jalur inflamasi berbeda (netrofil dan limfosit) untuk memprediksi luarannya, dan beberapa studi telah menunjukkan manfaatnya dalam memprediksi Major Adverse Cardiac Events (MACE). Penelitian ini bertujuan untuk membuktikan manfaat RNL dalam stratifikasi risiko SKA pada populasi Indonesia, dan menentukan nilai titik potong RNL untuk peningkatan risiko MACE. Metode: 380 rekam medis pasien SKA dari Januari 2012-Agustus 2015 diikutkan dalam studi ini. Karakteristik, faktor risiko kardiovaskuler, dan hasil pemeriksaan laboratorium subjek dikumpulkan dan diikuti secara retrospektif untuk menilai kemunculan MACE (aritmia, infark ulang, in-stent restenosis, gagal jantung akut, syok kardiogenik, kematian) selama perawatan. Nilai RNL didapatkan dari pembagian hitung netrofil dan limfosit absolut. Analisis statistik untuk menentukan nilai titik potong RNL dan penyesuaian untuk faktor perancu dilakukan untuk memvalidasi hasil. Hasil: Subjek mayoritas merupakan laki-laki, dengan rerata usia 57,92 tahun. Hipertensi dan merokok merupakan faktor risiko yang paling sering ditemukan. Rerata RNL subjek adalah 4,72, dan MACE ditemukan pada 73 kasus (19,2%). Setelah analisis ROC, didapatkan nilai titik potong sebesar 3.55 (sensitivitas 72,6%, spesitifitas 60,6%, AUC 0.702). Ditemukan bahwa terdapat peningkatan insidens MACE pada kelompok RNL>3.55 (30.47% vs 9.71% pada ≤3.55, p<0.001). Setelah penyesuaian untuk faktor perancu, RNL>3.55 tetap signifikan dalam memprediksi MACE (p=0.02, adujsted OR 2,626 (IK95% 1,401-4,922)). Kesimpulan: RNL>3.55 adalah prediktor independen untuk kejadian MACE. ...... Background: Neutrophil-Lymphocyte Ratio (NLR) is a low-cost, readily available laboratory examination in various places, and is currently emerging as a prognostic marker for various conditions, including Acute Coronary Syndrome (ACS). NLR, which combines two different inflammatory pathways (neutrophil and lymphocyte), have been shown by several studies to be useful in predicting Major Adverse Cardiac Events (MACE). This study aims to prove NLR’s use in ACS risk stratification in Indonesians and determine a cutoff level for MACE risk increase. Methods: 380 ACS patients’ medical records from January 2012 to August 2015 were included in this study. Subjects’ characteristics, cardiovascular risk factors and laboratory findings were collected, and retrospectively followed to evaluate for MACE (arrhythmia, reinfarction, in-stent restenosis, acute heart failure, cardiogenic shock, death) during hospitalization. NLR value was calculated from neutrophil and lymphocyte counts division. Statistical analysis to determine NLR cutoff point for MACE risks, and adjustment for confounding factors were done for results validation. Results: Subjects were predominantly male, with average age of 57.92 years old. Hypertension and smoking were the most frequent risk factors found. Average NLR was 4.72, and MACE was found in 73 cases (19.2%). After ROC analysis, a cutoff of 3.55 was determined to be satisfactory (sensitivity 72.6%, spesitivity 60.6%, AUC 0.702). It was found that there is a significant increase in MACE incidence in NLR>3.55 (30.47% vs 9.71% in ≤3.55, p<0.001). After adjusting for confounding factors, NLR>3.55 was still significant in predicting MACE (p=0.02, adujsted OR 2,626 (CI95% 1,401-4,922)). Conclusion: NLR>3.55 is an independent predictor of in-hospital MACE.

Abstrak :
Kejadian sindrom koroner akut (SKA) pada pasien risiko atau suspek penyakit jantung koroner (PJK) terkait dengan tipe plaque-nya. Coronary Computed Tomography Angiography (CCTA) merupakan modalitas pilihan untuk melihat adanya soft plaque, mixed plaque dan calcified plaque pada arteri koronaria. Mengetahui hubungan antara vulnerable plaque dengan kejadian SKA pada pasien yang telah diperiksa CCTA menjadi informasi tambahan dalam evaluasi dan penatalaksanaan pasien. Metode.: Penelitian retrospektif dengan comparative cross sectional pasien risiko atau suspek PJK yang menjalani pemeriksaan CCTA yang terdapat soft plaque dan mixed plaque yang termasuk vulnerable plaque serta calcified plaque. Dilakukan penilaian rerata Hounsfield Unit dan perhitungan remodeling indeks (RI) untuk melihat komponen positif remodeling (PR). Hasil : Terdapat hubungan yang bermakna pada vulnerable plaque yang mengalami SKA dengan nilai p < 0,001 dan OR : 6.55. Selain itu didapatkan juga hubungan yang bemakna antara soft plaque dan mixed plaque dengan positif remodeling dibandingkan tanpa positif remodeling dengan nilai p : 0,039 dan OR : 2,92. Kesimpulan : Terdapat hubungan yang bermakna antara vulnerable plaque pada pasien risiko atau suspek PJK dengan kejadian SKA Background and Objective : Acute coronary syndrome (ACS) event in risk or suspect of coronary artery disesase depent on their plaque type. Coronary Computed Tomography Angiography (CCTA) is modality of choice to recognise soft plaque, mixed plaque and calcified plaque in coronary artery disease (CAD). Correlation between vulnerable plaque with ACS event in risk or suspek CAD that already examined by CCTA have additional information for evaluation and treatment patient.Methods : Comparative cross sectional retrospective study patient with risk or CAD that already examined by CCTA that contain soft plaque and mixed plaque that categorized as vulnerable plaque and calcified plaque, also assessment average value of Hounsfield Unit and quantification of remodeling index (RI) to see the positive remodeling (PR). Results :There is correlation in vulnerable plaque related to ACS with p < 0,001 and OR : 6,55. Besides that there also correlation between soft plaque and mixed plaque with posistif remodeling compare without positive remodeling with value p 0,039 and OR : 2,92. Conclusions : There is correlation between ACS event and vulnerable plaque in patient with risk or suspect CAD

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Latar Belakang: Kematian kardiak dan reinfark merupakan MACE yang sering terjadi pada pasien SKA. Gelombang fragmented QRS fQRS merupakan penanda iskemia atau jejas miokardium dini pada pasien sindrom koroner akut SKA. Peran fQRS terhadap MACE 30 hari perlu diteliti lebih lanjut pada pasien SKA. Tujuan: Mengetahui peran fQRS sebagai prediktor MACE berupa reinfark dan kematian kardiak pada pasien SKA di ICCU selama 30 hari. Metode: Studi dengan desain kohort retrospektif untuk meneliti peran gelombang fragmented QRS sebagai prediktor MACE selama 30 hari pasien SKA, dengan menggunakan data rekam medis pasien SKA yang menjalani perawatan di ICCU RSCM pada bulan Juli 2015 - Oktober 2017. Analisis bivariat dan multivariat dengan logistik regresi dilakukan untuk menghitung crude risk ratio RR dan adjusted RR terjadinya MACE dalam 30 hari antara kelompok fQRS terhadap kelompok non-fQRS dengan menggunakan SPSS. Hasil: Dalam 2 tahun, didapatkan jumlah subyek yang memenuhi kriteria inklusi dan eksklusi sebanyak 353 orang. Fragmented QRS didapatkan pada 60,9 subyek, dengan lokasi terbanyak di inferior 48,8 dan rerata onset 34 jam. Proporsi kejadian MACE 30 hari lebih tinggi pada grup fQRS vs non fQRS 15,8 vs 5,8. Pada analisis bivariat didapatkan fQRS meningkatkan probabilitas terjadinya MACE selama 30 hari pada pasien SKA, dengan risiko relatif RR sebesar 2,72 IK 95 1,3 -5,71. Sedangkan pada analisis multivariat, didapatkan adjusted RR 2,79 IK 95 1,29 - 4,43, setelah memperhitungkan 6 faktor perancu, yakni skor GRACE risiko sedang-berat, eGFR kurang dari 60 ml/menit, LVEF kurang dari 40, riwayat diabetes melitus, usia lebih dari 45 tahun dan hipertensi. Laju eGFR merupakan faktor perancu yang memberikan perubahan paling besar, yakni 12,4. Kesimpulan: Proporsi fQRS pada SKA selama perawatan di ICCU RSCM sebesar 60,9. Fragmented QRS yang muncul pada fase akut pada pasien SKA yang dirawat di ICCU merupakan prediktor independen terjadinya MACE dalam 30 hari dan meningkatkan probabiltas terjadinya MACE 30 hari berupa kematian kardiak dan reinfark pada pasien SKA. ...... Background: Cardiac death and reinfarction are most common major adverse cardiac events in acute coronay syndrome. Fragmented QRS fQRS in 12 leads ECG is associated with myocardial injury and ischaemia in coronary artery disease. The role of fQRS as predictor of 30 days MACE cardiac death and reinfarction needs to be evaluated in acute coronary syndrome patients in Indonesia. Objectives: To identify proportion and role of fQRS as a predictor 30 days MACE in acute coronary syndrome patients. Methods: A cohort retrospective study was conducted by using secondary data acute coronary syndrome patients in Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 ndash October 2017. Analysis was done by using SPSS statistic for univariate, bivariate and multivariate logistic regression to obtain crude risk ratio and adjusted risk ratio of probability 30 days MACE patient with fQRS. Result: Three hundred and fifty three subjects during 2 years were included in this study. Fragmented QRS was found in 60,9 subjects, more frequent in inferior leads 48,8, with mean onset 34 hours. Major adverse cardiac events were higher in fQRS vs non fQRS group 15,8 vs 5,8. Bivariate analysis showed higher probability of 30 days MACE in ACS patient RR 2,72, 95 CI 1,3 5,71. Multivariate analysis were done by using logistic regression with GRACE score moderate and high risk, low eGFR 60 ml min, low LVEF 40, diabetes melitus, age more than 45 years and hypertension as confounding factors, revealed adjusted RR was 2,79 95 CI 1,29 ndash 4,43. Low eGFR was a potential confounder in this study. Conclusion: The fQRS proportion in ACS patients during ICCU admission was 60,9. Acute and persistent fQRS developed in ACS during hospitalization was an independent predictor of 30 days MACE cardiac death and reinfarction.Keywords fQRS, acute coronary syndrome, Major adverse cardiac event.

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Latar belakang: Sindrom koroner akut SKA merupakan penyebab utama peningkatan morbiditas dan mortalitas di seluruh dunia. Mortalitas SKA dari berbagai studi di luar negeri diketahui berhubungan dengan kadar kalium serum saat admisi. Penelitian mengenai hubungan kadar kalium serum dengan mortalitas pada SKA masih perlu dilakukan karena adanya kemajuan dalam terapi kardiovaskular yang cukup pesat terutama pada era PCI saat ini dan adanya hasil yang bertolakbelakang antara studi terbaru dengan panduan yang ada. Tujuan: Menilai hubungan antara kadar kalium serum saat admisi dengan mortalitas selama perawatan pasien SKA in-hospital mortality. Metode: Data kadar kalium dan kematian diperoleh dari rekam medis dengan desain studi kohort retrospektif terhadap 673 pasien SKA yang dirawat dengan sindrom koroner akut di RSUPN Cipto Mangunkusumo. Keluaran utama yang diamati berupa mortalitas selama perawatan. Analisis bivariat dengan Pearson Chi-square dan multivariat menggunakan regresi logistik dilakukan untuk menentukan hubungan antara kadar kalium serum abnormal dengan kematian pada sindrom koroner akut. Hasil dan Pembahasan: Subjek yang datang dengan kadar kalium serum yang abnormal K < 3,50 mEq/L atau > 5,0 mEq/L saat admisi sebesar 24,22 163 pasien , sedangkan grup dengan kalium normal sebesar 510 subjek 75,78. Dari analisis regresi logistik, setelah adjustment terhadap faktor perancu eGFR, didapatkan hubungan yang bermakna antara kadar kalium serum abnormal saat admisi dengan mortalitas selama perawatan dengan nilai p = 0,04 adjusted RR 2,184; 95 CI: 1,037-4,601. Terjadi peningkatan risiko mortalitas pada subjek dengan kadar serum kalium 4,0- ...... Background: Acute coronary syndrome ACS is the leading cause of increased morbidity and mortality across the globe. This mortality was known to be associated to the serum potassium level on admission. More studies are still needed due to rapid advancement in cardiovascular medicine especially in the era of interventional cardiology and also the conflicting results that exist between recent studies and established guidelines. Aims: To determine association between serum potassium levels on admission of subjects with acute coronary syndrome and in-hospital mortality. Methods: Included in the study were 673 acute coronary syndrome patients hospitalised in Indonesian National Cipto Mangunkusumo Hospital. The outcome of the study was all-cause in-hospital mortality. Logistic regression models adjusted for risk factors, hospital treatment, and co-morbidities were constructed. Results: Total of 163 patients 24,22 with abnormal serum potassium K < 3,50 mEq/L or > 5,0 mEq/L and 510 subjects with normal serum potassium 75.78. Logistic regression analysis after adjustment of the confounder eGFR shows significant association between serum potassium level on admission and in-hospital mortality with p value of 0,04 adjusted RR 2.184; 95 CI: 1.037-4.601. The risk of dying for patients with serum potassium of 4.0-.

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Latar belakang: Pasien sindom koroner akut (SKA) dengan gejala ansietas berisiko mengalami luaran negatif yang dimediasi oleh disfungsi otonom yang dapat dinilai dengan variabilitas denyut jantung (VDJ). Penurunan VDJ ditemukan baik pada pasien SKA maupun ansietas. Penelitian ini bertujuan untuk mengetahui perbedaan nilai VDJ pada pasien SKA dengan gejala ansietas dibandingkan dengan tanpa gejala ansietas dan menentukan korelasi antara nilai VDJ dengan gejala ansietas. Metode: Penelitian ini merupakan studi potong lintang. Subjek penelitian diambil dari data penelitian utama pada pasien SKA yang dirawat di ruang intensif rawat jantung RSCM periode April-September 2021 secara total sampling. Gejala ansietas dinilai dengan kuesioner. Hospital Anxiety and Depression Scale (HADS). Data VDJ yang diambil adalah domain waktu (SDNN, RSSMD) dan frekuensi (LF, HF, rasio LF/HF). Uji Mann-Whitney dilakukan untuk perbedaan nilai VDJ antara subjek dengan gejala ansietas dibanding tanpa gejala ansietas, uji Spearman untuk korelasi antara nilai VDJ dengan gejala ansietas, dan analisis multivariat untuk faktor perancu. Hasil: Tujuh puluh subjek SKA yang dilibatkan terdiri dari 23 subjek dengan gejala ansietas dan 47 subjek tanpa gejala ansietas. Tidak didapatkan perbedaan nilai VDJ (SDNN, RMSSD, LF, HF, rasio LF/HF) antara subjek dengan gejala ansietas dibanding tanpa gejala ansietas secara statistik. Setelah mengontrol variabel perancu, gejala ansietas memiliki korelasi dengan SDNN (r = -0,563; p<0,001) yang dipengaruhi oleh usia (p<0,004); sementara nilai LF (r = -0,63; p< 0,001) dipengaruhi oleh usia (p = 0,007) dan penyekat beta (p = 0,030). Kesimpulan: Tidak didapatkan perbedaan nilai VDJ antara pasien SKA dengan gejala ansietas dibanding tanpa gejala ansietas yang bermakna secara statistik, namun terdapat penurunan nilai SDNN, HF, dan rasio LF/HF pada kelompok dengan gejala ansietas yang lebih besar. Terdapat korelasi antara nilai VDJ (SDNN dan LF) dengan gejala ansietas pada pasien SKA. ......Background: Acute coronary syndrome (ACS) patients with anxiety symptoms are at high risk of developing poor outcomes mediated by autonomic dysfunction that can be assessed with heart rate variability (HRV). Reductions in HRV are reported not only in ACS but also in anxiety. This study aims to compare HRV of ACS subjects with and without anxiety and to determine the correlation between HRV and anxiety symptoms. Methods: This research is a cross-sectional study. The study subjects were taken from the primary research data of ACS patients treated at the ICCU of RSCM from April to September 2021 by total sampling. Anxiety symptoms are assessed with Hospital Anxiety and Depression Scale (HADS) questionnaire. HRV analysis consist of time (SDNN, RSSMD) and frequency (LF, HF, LF/HF ratio) domain. Data were analyzed using Mann- Whitney test for differences in HRV between ACS subjects with anxiety symptoms compared to those without anxiety symptoms, Spearman's test for the correlation between HRV and anxiety symptoms, and multivariate analysis for confounding factors. Results: Seventy ACS subjects involved consisted of 23 subject with anxiety symptoms and 47 without anxiety symptoms. There was no statistical difference in comparison of HRV (SDNN, RMSSD, LF, HF, LF/HF ratio) between anxiety symptoms compare to those without anxiety symptoms. After controlling for confounding variables, SDNN has a correlation with anxiety symptoms (r = -0,563; p<0,001) which was influenced by age (p<0,004); while the LF has a correlation (r = -0,63; p< 0,001) which are influenced by age (p = 0,007) and beta blockers (p = 0,030). Conclusion: There was no significant difference in HRV values (SDNN, RMSSD, LF, HF, ratio LF/HF) between ACS patients with anxiety symptoms compared to those without anxiety symptoms. There was a correlation between HRV (SDNN and LF) and anxiety symptoms.