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"Latar Belakang:Keterlambatan penanganan pasien STElevation Myocardial Infarction(STEMI)menjadi penyebab tingginya mortalitas dan kejadian MACE (Major Adverse Cardiac Events). Di Indonesia, pasien pasien STEMI sering mengalami keterlambatan penanganan. Upaya yang dapat dilakukan di fasilitas kesehatan dengan kemampuan Primary Percutaneous Coronary Intervention(PCI) adalah mencapai reperfusi tepat waktu pasien STEMI. Berbagai strategi dilakukan untuk mencapai reperfusi tepat waktu diantaranya dengan menerapkan program CODE STEMI. Program CODE STEMI merupakan notifikasi STEMI melalui sistem panggilan tunggal yang dapat mempercepat waktu reperfusi pasien STEMI di rumah sakit.Tujuan:Mengetahui pengaruh penerapan program CODE STEMI terhadap Door to Balloon Time (D2BT) dan MACE pasien STEMI yang menjalani PrimaryPCI di RSUPN Cipto Mangunkusumo Jakarta.Metode:Penelitian ini merupakan studi kohort retrospektif pada 255 rekam medis pasien STEMI yang menjalani PrimaryPCI di RSUPN Cipto Mangunkusumo sebelum penerapan program CODE STEMI (2015-2016) dan sesudah penerapan program CODE STEMI (2017-2018). Analisis data dilakukan secara kuantitatif dengan uji Mann whitney untuk D2BT dan chi square untuk MACE.Hasil:Terdapat 111 pasien pada kelompok Non CODE STEMI dan 144 pasien pada kelompok CODE STEMI. D2BT berkurang bermakna 110 menit dari 275 (99-2356) menit pada kelompok Non CODE STEMI menjadi 165 (67-1165) menit pada kelompok CODE STEMI (p <0.001). Kejadian MACE (48,4% vs 51,6%; p = 0,120), gagal jantung (46,6% vs 42 %; p = 0,288), syok kardiogenik (27% vs 19,4%; p = 0,152), aritmia (12,6% vs 6,2%; p = 0,079), stroke (4,5% vs 5,6%; p = 0,705) dan angka mortalitas (7,2% vs 3,5%; p = 0,179) sama antara kedua kelompok.Kejadian infark berulang dan PCI ulang berkurang bermakna pada kelompok CODE STEMI (4,5% vs 0,7%; p = 0.047, 2,7% vs 0,0%; p = 0.047).Simpulan:Program CODE STEMI memperbaiki D2BT. Program CODE STEMI tidak menurunkan kejadian MACE.

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Background: Delay in the management of ST Elevation Myocardial Infarction (STEMI)patients is a cause of high mortality and the incidence of Major Adverse Cardiac Events (MACE).In Indonesia, STEMI patients often experience delays in treatment. Efforts that can be made in health facilities with Primary PercutaneousCoronary Intervention(PCI)capability are achieving timely reperfusion of STEMI patients. Various strategies were carried out to achieve timely reperfusion including implementationthe CODE STEMI program. The CODE STEMI program is a STEMI notification through a single call system that can speed up the reperfusion time of STEMI patients in the hospital.

Objective:To determine the effect of the implementation of the CODE STEMI program on Door to Balloon Time (D2BT) and MACE of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital Jakarta.

Methods: This was a retrospectivecohort study on 255 medical records of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital before the application of the CODE STEMI program (2015-2016) and after the application of the CODE STEMI program (2017-2018). Data analysis was performed quantitatively by Mann Whitney test for D2BT and chi square for MACE

Results:There were 111 patients in the Non CODE STEMI group and 144 patients in the CODE STEMI group. D2BT decreased significantly 110 minutes from 275 (99-2356) minutes in the Non CODE STEMI group to 165 (67-1165) minutes in the CODE STEMI group (p <0.001). MACE events (48.4% vs 51.6%; p= 0.120), heart failure (46.6% vs 42%; p = 0.288), cardiogenic shock (27% vs 19.4%; p = 0.152), arrhythmia (12.6% vs 6.2%; p = 0.079), stroke (4.5% vs 5.6%; p = 0.705) and mortality rate (7.2% vs 3.5%; p = 0.179 ) were similar between the two groups. The incidence of reinfarction and repeated PCI was significantly reduced in the CODE STEMI group (4.5% vs 0.7%; p = 0.047, 2.7% vs 0.0%; p = 0.047).C

onclusions:The CODE STEMI program reduces D2BT. The CODE STEMI program did not reduce the overall MACE incidence but reduced the incidence of reinfarction and repeated PCI of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital. "

"Latar Belakang: Keparahan stenosis pada penyakit jantung koroner (PJK) stabil berkaitan erat dengan prognosis. Dalam memprediksi keparahan stenosis dapat digunakan beberapa faktor klinis dan ekokardiografi. Akhir-akhir ini berkembang speckle tracking echocardiography yang mampu menilai strain miokardium dan baik untuk memprediksi stenosis. Penilaian faktor-faktor klinis dan ekokardiografi strain bersama-sama diharapkan mampu memprediksi lebih baik keparahan stenosis. Tujuan: Mengetahui apakah faktor-faktor klinis (usia, jenis kelamin, diabetes, angina tipikal, riwayat infark) dan global longitudinal strain (GLS) pada ekokardiografi strain dapat memprediksi keparahan stenosis pasien PJK stabil yang dinilai dengan skor Gensini. Membuat model prediktor dari parameter yang bermakna. Metode: Studi potong lintang dilakukan di RSCM pada periode Maret-Mei 2019. Pengambilan sampel secara konsekutif pada pasien PJK stabil yang menjalani angiografi koroner. Analisis bivariat dilakukan dengan chi-square, dilanjutkan analisis multivariat dengan regresi logistik metode baickward stepwise pada variabel yang bermakna. Hasil: Terdapat 93 subjek yang masuk dalam penelitian. Pada analisis bivariat faktor-faktor prediktor yang bermakna adalah diabetes melitus (OR 2,79; IK95%:1,08-7,23), riwayat infark (OR 4,04; IK95%:1,51-10,80), angina tipikal (OR 5,01; IK95%:1,91-13,14), dan GLS ≥-18,8 (OR 30,51; IK95%:10,38-89,72). Pada analisis multivariat faktor-faktor prediktor yang bermakna adalah angina tipikal (OR 4,48; IK95%:1,39-14,47) dan GLS ≥18,8 (OR 17,30; IK95%:5,38- 55,66). Tidak dilakukan pembuatan model prediktor karena hanya 2 faktor prediktor yang bermakna. Simpulan: Angina tipikal dan GLS merupakan faktor-faktor prediktor keparahan stenosis pada pasien PJK stabil, sedangkan faktor usia, jenis kelamin, diabetes, dan riwayat infark bukan merupakan prediktor keparahan stenosis pasien PJK stabil. Model skor prediktor tidak dikembangkan karena hanya 2 faktor prediktor yang bermakna.

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Background: In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical and echocardiographic parameters can predict severity of stenosis. Recently a new method in echocardiography called speckle tracking echocardiography can be used to asses myocardial strain, which is a good predictor of stenosis severity. Assessment of clinical parameters together with strain echocardiography parameter is expected to make better prediction. Objective: To determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain, can predict severity of coronary artery stenosis measured with Gensini score. To further develop a prediction model based on significant parameters. Methods: This is a cross-sectional study taken at Cipto Mangunkusumo Hospital during period March-May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi- square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. Results: The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; CI95%:1.08-7.23), history of myocardial infartion (OR 4.04; CI95%:1.51-10.80), typical angina (OR 5.01; CI95%:1.91-13.14), and GLS ≥-18.8 (OR 30.51; CI95%:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; CI95%:1.39-14.47) and GLS ≥18.8 (OR 17.30; CI95%:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions: Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors."

"Latar Belakang: Penyakit jantung koroner (PJK) merupakan penyebab kematian penyakit kardiovaskular utama di Indonesia. Angka kematian akibat STEMI di Indonesia mencapai 18,6%. Revaskularisasi fase akut secara mekanis maupun farmakologis merupakan tatalaksana utama pada STEMI. Mortalitas paska revaskularisasi masih tinggi. Salah satu faktor penting yang memengaruhi kesintasan pasien STEMI adalah fungsi ginjal. Gangguan fungsi ginjal yang dicerminkan dengan estimated glomerulus filtration rate (eGFR) < 60 diketahui berhubungan dengan perfusi miokard yang buruk paska IKP primer.Tujuan: Memberikan gambaran karakteristik pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP dan menganalisa perbedaaan kesintasan dalam 30 hari pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP.Metode: Studi observasional kohort retrospektif, penelitian dilakukan periode 2021 hingga 2022 dengan subjek pasien STEMI yang menjalani IKP primer di RSUP Dr. Cipto Mangunkusumo Jakarta periode 2018 hingga 2022. Fungsi ginjal dikelompokkan berdasarkan eGFR dengan rumus CKD-EPI menjadi dua yaitu eGFR < 60 dan eGFR ≥ 60.Hasil: IKP primer dilakukan pada 211 pasien STEMI, pasien dikelompokkan menjadi dua yaitu eGFR < 60 dan eGFR ≥ 60. Dibandingkan dengan pasien eGFR ≥ 60, pasien dengan eGFR < 60 sebanyak 75 orang dengan usia yang lebih tua, riwayat hipertensi, diabetes mellitus, dislipidemia, riwayat infark miokard dan riwayat IKP primer dengan presentase yang lebih tinggi. Jenis kelamin didominasi oleh laki-laki pada kedua kelompok. Median eGFR pada kelompok eGFR < 60 yaitu 40. Insiden mortalitas eGFR < 60 sebesar 14,7%, sedangkan dengan eGFR ≥ 60 sebesar 4,4%. Pada analisis bivariat didapatkan perbedaan kesintasan yang bermakna pasien STEMI-IKP antar-kelompok eGFR (p < 0,05) dengan crude HR (IK95%) 3,433 (1,269-9,284). Tidak terdapat perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR setelah di-adjusted dengan berbagai variabel perancu. Variabel yang paling berpengaruh adalah riwayat gagal jantung kongestif, Killip class dan hipertensi.Simpulan: Mortalitas dalam 30 hari pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP pada kelompok eGFR < 60 lebih tinggi dibandingkan dengan kelompok eGFR ≥ 60. Tidak terdapat perbedaan kesintasan dalam 30 hari pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP setelah di-adjusted dengan variabel riwayat gagal jantung kongestif, Killip Class dan hipertensi.

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Background: Coronary heart disease is the primary cause of death from cardiovascular disease in Indonesia. STEMI mortality rate in Indonesia reaches 18.6%. Mechanical and pharmacological revascularization of the acute phase is the main treatment for STEMI. Mortality after revascularization remains high. One important factor that influences STEMI patients' survival is renal function.Impaired renal function as reflected by an estimated glomerular filtration rate (eGFR) < 60 is associated with poor myocardial perfusion after primary PCI.

Objective: Provide an overview of the characteristics of STEMI patients undergoing primary PCI based on renal function before PCI and analyze the difference in survival in 30 days of STEMI patients undergoing primary PCI based on renal function before PCI.

Methods: A retrospective cohort observational study, the study was conducted from 2021 to 2022 with the subject of STEMI patients undergoing primary PCI at RSUP Dr. Cipto Mangunkusumo Jakarta for the period 2018 to 2022. Renal function is grouped based on eGFR with the CKD-EPI formula into two, eGFR < 60 and eGFR ≥ 60.

Results: Primary PCI was performed on 211 STEMI patients, patients were grouped into two, eGFR < 60 and eGFR ≥ 60. Compared with eGFR ≥ 60, 75 patients with eGFR < 60 were older, had hypertension, diabetes mellitus, dyslipidemia, history of myocardial infarction, and history of primary PCI with a higher percentage. Gender was dominated by males in both groups. The median eGFR in the eGFR < 60 groups was 40. The incidence of mortality of eGFR < 60 was 14.7%, whereas eGFR ≥ 60 was 4.4%. In the bivariate analysis, there were significant differences in survival between STEMI-PCI patients between eGFR groups (p < 0.05) with crude HR (CI 95%) 3.433 (1.269-9.284). There was no difference in the survival of STEMI-PCI patients between eGFR groups after adjusting for various confounding variables. The most influential variables were history of congestive heart failure, Killip class, and hypertension.

Conclusions: 30-days-mortality of STEMI patients undergoing primary PCI based on renal function before PCI in the eGFR < 60 groups was higher than in the eGFR ≥ 60 group. There was no difference in the 30-days-survival of STEMI patients undergoing primary PCI based on renal function after adjusting with several variables such as history of congestive heart failure, Killip Class and hypertension."

"Latar belakang: Diabetes melitus merupakan faktor risiko penting terjadinyaaterosklerosis, aterosklerosis merupakan penyakit sistemik yang bisa terjadi di seluruhpembuluh darah baik pada mikrovaskular maupun makrovaskular. Adanya buktiiskemia akibat stenosis yang disebabkan aterosklerosis pada salah satu pembuluh darah,mengharuskan kita lebih waspada akan adanya proses aterosklerosis di tempat lain.NPD di kaki terjadi akibat komplikasi diabetes pada mikrovaskular yang akhirnyamengakibatkan kerusakan pada persarafan di kaki. Maka perlu mewaspadai prosesateroslerosis di tempat lain, baik pada pembuluh arteri makro maupun mikrovaskular dikaki. Pemeriksaan non invasif untuk melihat adanya ganguan makrovaskular di kakimenggunakan ABI dan TBI sedangkan untuk gangguan mikrovaskular dengan TcPO2.Penelitian ini dilakukan untuk dapat menilai hubungan derajat neuropati perifer diabetikyang dinilai dengan TCSS dengan proses ateroskerosis dipembuluh darah kaki, baikyang makrovaskular dengan ABI dan TBI maupun mikrovaskular TcPo2 pada pasienDM tipe 2.Metode: Penelitian potong lintang dilakukan pada pasien DM tipe 2 dengan NPDdengan nilai TCSS >5 di Poliklinik Pelayanan Jantung Terpadu, poliklinik Endokrindan Metabolik dan Poliklinik Ilmu Penyakit Dalam Umum RSCM. Data diperoleh dariwawancara, rekam medik, pemeriksaan ABI, TBI dan TcPO2. Variabel penelitianberupa derajat neuropati perifer, ABI, TBI dan TcPO2. Analisis bivariat terhadapmasing-masing variable dengan menggunakan uji Spearman.Hasil: Sebanyak 36 subjek yang memenuhi kriteria pemilihan diikutkan dalampenelitian, rerata usia 62 tahun dengan 20 (55,6%) di antaranya perempuan dan medianlama diabetes 12 tahun. Berdasarkan analisa bivariat dengan uji spearman penelitian inimendapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasisedang antara derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan ABI(r = -0,475, p = 0,003) dan TBI (r = -0,421, p = 0,010). Dan pada pemeriksaan TcPO2juga di dapatkan korelasi negatif yang bermakna secara statistik dengan koefisienkorelasi sedang ( r = -0,399, p = 0,016)Simpulan : Terdapat korelasi negatif yang bermaksa secara statistik antara derajatneuropati perifer diabetik dengan ABI, TBI dan TcPO2.

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Background: Diabetes mellitus is important risk factor of atherosclerosis.

Atherosclerosis is systemic disease that can occur in all blood vessels both

microvascular and macrovascular. There is evidence of ischemia due to stenosis caused

by atherosclerosis in one blood vessel, which requires us to be more aware with the

process of atherosclerosis in other places. Diabetic peripheral neuropathy (DPN) in the

lower extremity results from complications of diabetes in the microvascular which can

damage nerve in the lower extremity. Then it is necessary to be aware of the process of

aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower

extremity. Non-invasive examination to look macrovascular disorders in the lower

extremity are using ankle brachial index (ABI) and toe brachial index (TBI) while for

microvascular disorders with TcPO2. This study was conducted to assess the

association of the degree of diabetic peripheral neuropathy assessed by toronto clinical

scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the

lower extremity, both macrovascular with ABI and TBI as well as microvascular TcPo2

in Patients with type 2 diabetes mellitus (DM)

Methods: Cross-sectional study was carried out in patients with type 2 DM with DPN

with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic

Polyclinic, and Internal Medicine Polyclinics at RSCM. The Data were obtained from

interviews, medical records, ABI, TBI and TcPO2 examinations. The research variables

are the degree of peripheral neuropathy, ABI, TBI and TcPO2. Bivariate analysis of

each variable was used the Spearman test.

Results: Total of 36 subjects who met the selection criteria were included in the study,

the average age was 62 years with 20 (55.6%) of whom were women and the median

duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test,

this study found a statistically significant negative correlation with moderate correlation

coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with

ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010) . The TcPO2 examination

also found a statistically significant negative correlation with moderate correlation

coefficient (r = -0.399, p = 0.016)

Conclusion : There is a statistically significant negative correlation between the degree of diabetic peripheral neuropathy with ABI, TBI and TcPO2 examinations."