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Abstrak :
Coronary artery disease (CAD) is an important cause of death in end-stage renal disease (ESRD) patients on regular hemodialysis. The high risk of CAD occurrence in ESRD patients is partially due to a high prevalence of established atherosclerotic risk factors, which are hypertension, diabetes and dyslipidemia. However, unique renal-related risk factors are also likely to contribute to this high risk of CAD. The high prevalence of hyperhomocysteinemia in ESRD patients is of interest because of the probable cardiovascular risk associated with the increase of total plasma homocysteine concentration. The aim of this study was to evaluate the role of homocysteine as a risk factor for CAD in non-diabetic ESRD patients on regular hemodialysis. Total fasting plasma homocysteine, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, hypertension and smoking habit were documented from 80 non-diabetic ESRD patients on regular hemodialysis (48 men, 32 women; mean age 54.5±6.5 years). Twenty-two (27.5%) among these patients suffered from CAD according to ECG and echocardiographic criteria. The risk of CAD was analyzed using a stepwise multiple logistic regression. Total fasting plasma homocysteine concentration and other risk factors for CAD were also determined in 80 age- and sex-matched normal controls. Total fasting plasma homocysteine concentration was significantly higher in non-diabetic ESRD patients than in normal controls (26.0±1.5 versus 14.6±1.3 fimol/L; p<0.01). Hyperhomocysteinemia was observed in 92.5% ESRD patients. Homocysteine concentration was significantly higher in ESRD patients with CAD than without CAD (33.8±1.4 versus 23.5+1.5 umol/L; p<0.01). High total plasma homocysteine concentration and hypertension were independently associated with CAD in non-diabetic ESRD patients on regular hemodialeine concentration in the upper tertile (>30.6 jxmol/L) had an adjusted odds ratio of 2.95 (CI, 1.02 to 8.53; p<0.05). In ESRD patients, the intake of folic acid is the only factor associated with total plasma homocysteine concentration. The increase of total plasma homocysteine concentration in normal controls was associated with increased age and smoking habit. This study concludes that a high total plasma homocysteine concentration is an independent risk factor for coronary artery disease in non-diabetic ESRD patients on regular hemodialysis.

Abstrak :
Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK. ......Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG.

Abstrak :
Latar Belakang: Studi epidemiologi menunjukkan bahwa DM merupakan salah satu faktor dalam proses terjadinya aterosklerosis dan mempengaruhi secara nyata kesaldtan dan kematian akibat PIK. Dibandingkan dengan penderita bukan DM, penderita DM 2-4 kali lebih banyak menderita P3K dan 2-4 kali lebih banyak mengalami kematian jangka pendek setelah menderita serangan infark miokard akut Dewabrata mendapati 23,2% penderita infark miokard akut yang di rawat di RSCM selama periode 1994-1999. Data di Indonesia tersebut belum banyak menggambarkan bagaimana karakteristik penderita DM tersebut saat terbukti menderita infark miokard akut. Dengan demildan, gambaran penderita DM yang mengalami sindrom koroner akut merupakan ha! yang renting untuk diketahui, baik karakteristik klinis maupun komplikasi yang muncul akibat S1CA tersebut. Tujuan. Penelitian ini ingin mengetahui prevalensi SKA pada penderita DM tipe-2. Penelitian ini juga ingin mengetahui karakteristik klinis dan komplikasi SKA pada penderita DM tipe-2 serta perbandingannya dengan penderita bukan DM. Metodologi. Studi potong lintang retrospektif untuk mengetahui prevalensi dan karakteristik klinis serta studi kohort retrospektif untuk mengetahui perbandingan komplikasi SKA pads penderita DM tipe-2 dan penderita bukan DM, terhadap penderita yang dirawat di ICCU RSCM periode 1 Januari 2001 s.d. 31 Desember 2005. Hasil. Didapatkan data: Prevalensi SKA penderita DM tipe-2: 34,2%. Awitan nyeri penderita DM lebih lama, 70,7% vs 53,4%, p=0,001; 1K 95%; DR=2,259 (1,372-3,719). Nyeri dada tidak khas, didapati penderita DM lebih banyak, 17,3% vs 9,8% p~ 0,041; 1K 95%; OR=1,713 (1,019-2,881)_ Komplikasi: Gagal jantung: penderita DM tipe-2 Iebih banyak: 39,35% vs 16,8%, p=0,001; 11(95%; RR-3,213 (1,992-5,182). Untuk komplikasi syok kardiogenik, didapati penderita DM tipe-2 Iebih banyak, 16,2% vs 8,9%, p= 0,031; IK 95%; RR==1,983 (1,057-3,721). Sedangkan komplikasi kematian didapati penderita DM tipe-2 lebih banyak, 17,3% vs 6,3%, dengan p= 0,001; 1K 95%; RR= 3,116 (1,556-6,239). Simpulan. Didapatkan perbedaan karakteristik klinis SKA antara penderita DM tipe-2 dengan penderita SKA bukan DM. Awitan nyeri lebih lama dan keluhan nyeri dada yang tidak khan, Iebih banyak didapati Dada penderita DM tipe-2. Didapatkan juga perbedaan dalam hat komplikasi SKA. Kejadian gagal jantung, syok kardiogenik dan kematian didapatkan lebih tinggi pada penderita DM tipe-2.

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Background. Epidemiologic studies revealed diabetes mellitus (DM) as one of the factors involved in atherosclerosis process. DM also influence morbidity and mortality-related to coronary artery disease (CAD). Compared to non diabetic patients, type -2 DM patients suffer CAD 2-4 times more often and had increased short term mortality rate due to acute myocardial infarction 2-4 times more likely. During 1994-1999, Dewabrata found 23.2% of all acute myocardial infarction patients was diabetic patients treated in ICCU Cipto Mangunkusumo hospital. Unfortunately these data did not describe the clinical characteristic and complication ACS in type -2 DM patients. Therefore it is important to know the clinical characteristics and ACS related complications in type-2 DM patients. Objectives. To know the prevalence of type-2 DM among ACS patients, to learn clinical characteristics and ACS related complications in type-2 DM compared to non diabetic patients. Methods. A cross sectional retrospective study was performed to know the prevalence of ACS in type -2 DM patients and their clinical characteristics_ A retrospective cohort study was performed to compare the differences in ACS related complications in type -2 DM and non diabetic patients who were hospitalized in ICCU Cipto Mangunkusumo hospital during 5 years period (January 1st, 200I December 31st, 2005). Results. Prevalence of Type-2 DM among ACS patients : 34.2%. The onset of chest pain in type-2 DM patients was longer, 70.7% vs 53.4%, p=0.40l; CI 95%; OR=2.259 (1.372-3.719). Aypical chest pain were often in type-2 DM patients, 17.3% vs 9.8%; p= 0.041; CI 95%; OR 1.713 (L019 2.881). Heart failure as complications were more often found in type-2 DM patients, 39.35% vs 16.8%, p=0.001; CI 95%; RR=3.213 (1.992-5.182), cardiogenic shock were more often found in type-2 DM patients, 16.2% vs 8.9%, p= 0.031; CI 95%; RR 1.983 (1.057-3.721), and death were more often found in type-2 DM patients, 17.3% vs 6.3%, p= 0.001; CI 95%; RR= 3.116 (L556-6.239). Conclusions. There are differences in clinical characteristics of ACS between type-2 DM patients and non diabetic patients; which are longer onset of chestpain and atypical chestpain more often in type-2 DM patients. There are also differences in complications related ACS between Type-2 DM patients and non diabetic patients; heart failure, cardiogenic shock, and death more often in Type-2 DM patients.