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Abstrak :
ABSTRAK
Latar Belakang: Hiperglikemia admisi sebagai prediktor MACE pada SKA telah banyak diteliti, namun belum ada yang memperhatikan kesintasannya. Indonesia (ICCU RSCM khususnya), belum memiliki data epidemiologis mengenai hiperglikemia admisi pada SKA maupun pengaruhnya terhadap MACE dan kesintasannya. Penelitian ini dilakukan agar menjadi landasan untuk stratifikasi risiko selama perawatan.

Tujuan: Mengkaji hiperglikemia admisi sebagai prediktor MACE dan mengetahui kesintasan terhadap MACE pada berbagai kelompok hiperglikemia admisi pada SKA selama perawatan.

Metode: Kohort retrospektif dengan pendekatan analisis kesintasan terhadap 442 pasien SKA yang dirawat di ICCU RSCM Januari 2008-Mei 2012, terbagi 3 kelompok berdasarkan gula darah admisi (GD ≤140mg/dl, 141-200mg/dL, >200mg/dL). Kurva Kaplan Meier digunakan untuk mengetahui kesintasan masing-masing kelompok. Analisis bivariat mengunakan uji log-rank, analisis multivariat menggunakan cox proportional hazard regression. Besarnya hubungan variabel hiperglikemia admisi dengan MACE dinyatakan dengan crude HR dan IK 95% serta adjusted HR dan IK 95% setelah memasukkan variabel perancu.

Hasil dan pembahasan: 63 (14,25%) pasien mengalami MACE dengan kesintasan rata-rata 6,373 hari; SE 0,076 dan IK 95% 6,225-6,522. Analisis bivariat menunjukkan hubungan bermakna antara hiperglikemia admisi dengan kesintasan MACE (p<0,001). MACE tercepat terjadi berturut-turut pada GD admisi >200mg/dL, 141-200mg/dL, dan ≤140mg/dL dengan rata-rata kejadian secara berturut-turut pada hari perawatan ke-5,989; 6,078; 6,632. Analisis multivariat menunjukkan hiperglikemia admisi merupakan prediktor independen MACE selama perawatan (Adjusted HR 2,422; IK 95% 1,049-5,588 untuk GD admisi 141-200mg/dL dan Adjusted HR 3,598; IK 95% 1,038-12,467 untuk GD admisi >200mg/dL).

Simpulan: Kesintasan MACE pada pasien SKA selama 7 hari perawatan di ICCU RSCM adalah 85,7%, dan terdapat perbedaan kesintasan antara berbagai kelompok hiperglikemia admisi terhadap terjadinya MACE. Semakin tinggi kadar gula darah, semakin buruk kesintasannya (semakin tinggi risiko dan semakin cepat pula terjadi MACE)

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ABSTRACT
Background: Hyperglycemia on admission as a predictor for MACE in ACS has been studied for several circumstances, but none had seen it’s importance for survival. Cipto Mangunkusumo Hospital’s ICCU, had not have any epidemiological data about hyperglycemia on admission in ACS nor it’s influence to MACE and survival. This study was conducted to provide a platform for risk stratification during hospitalisation

Aim: To evaluate hyperglycemia on admission as a predictor for MACE and, to describe survival according to hyperglycemia on admission status in patients with ACS.

Methods: Retrospective cohort design and survival analysis was used to 442 ACS patients hospitalised at Cipto Mangunkusumo hospital’s ICCU between Januari 2008 and May 2012 that divided into 3 groups according to admission BG (≤140 mg/dL, 141-200 mg/dL and >200 mg/dL). Kaplan Meier curve utilised to evaluate the survival of each group. Bivariate analysis was conducted using Log-rank tes. Multivariate analysis was conducted using Cox proportional hazzard regression. The extend of relation between admission hyperglycemia and MACE was expressed with crude HR with 95% CI and adjusted HR with 95% CI after adjusting for confounders.

Results and discussion: MACE was found to happen to 63 (14.25%) patients with average survival of 6.373 days, SE 0.076 and 95% CI 6.225-6.522. Bivariate analysis found statistically significant relation hyperglycemia on between admission and MACE survival (p<0.001). MACE was significantly earlier in admission BG of >200 mg/dL, 141-200 mg/dL and ≤140 mg/dL respectively, with mean hospitalisation day at 5.989, 6.078 and 6.632 in that order. Multivariate analysis shown that hyperglycemia on admission was an independent predictor for MACE during hospitalisation (Adjusted HR 2.422; 95% CI 1.049-5.588 for BG 141-200 mg/dL and Adjusted HR 3.598; 95% CI 1.038-12.467 for BG >200 mg/dL).

Conclusion: Survival of MACE in ACS patient during 7 days hospitalisation in ICCU RSCM is 85,7%, and there was a survival difference between different admission hyperglycemia groups. The higher the blood glucose level, signify a worse survival and also faster and higher risk for MACE.

Abstrak :
Menentukan rerata kadar Protein C-Reaktif sensitivitas tinggi (hs-CRP) pada penyakit jantung koroner, hubungan antara kadar hs-CRP dengan luas lesi koroner dan fungsi sistolik jantung. Telah dilakukan penelitian observasional dengan disain potong lintang terhadap 106 pasien penyakit jantung koroner yang meliputi 90 angina pektoris stabil, 11 angina pektoris tidak stabil dan 5 infark miokard akut. Dilakukan pemeriksaan kadar kuantitatif hs-CRP, angiografi koroner untuk menentukan luas lesi koroner dan ejection fraction. Rerata kadar hs-CRP pada luas lesi koroner SVD 5,5 ± 7,6 mg/L, DVD 6,6 ± 21,7 mg/L dan TVD 5,5 ± 8,0 mg/L dengan p=0,056. Tidak didapatkan hubungan bermakna antara kadar hs-CRP dengan luas lesi koroner. Fungsi sistolik jantung mempunyai korelasi negatif dengan kadar hs-CRP (p=0,015, r = -0,235). Penelitian ini menunjukkan bahwa kadar hs-CRP tidak dapat menggambarkan luas lesi koroner, kadar hs-CRP mempunyai korelasi negatif dengan fungsi sistolik jantung. (Med J Indones 2003; 12: 201-6)

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To determine the mean value of high sensitivity C-Reactive Protein (hs-CRP), association between plasma level of hs-CRP with extent of disease and systolic function. A cross sectional study had been conducted to 106 coronary artery disease patients (90 stable angina pectoris, 11 unstable angina pectoris and 5 acute myocardial infarction). Plasma quantitative level of hs-CRP with cor angiography to determine extent of disease and ejection fraction were measured. The mean of hs-CRP levels in patients with SVD were 5,5 ± 7,6 mg/L, DVD were 6,6 ± 21,7 mg/L and TVD were 5,5 ± 8,0 mg/L and p=0,056, respectively. There were no significant association between hs- CRP levels with extent of disease. Systolic function had negative correlation with levels of hs-CRP (p=0,015, r=-0,235). This study showed that plasma level of hs-CRP cannot reflect the extent of disease, and it had negative correlation with systolic function. (Med J Indones 2003; 12: 201-6)

Abstrak :
Background: some studies show fragmanted QRS (fQRS) as a marker of myocardial scar, ventricular arrhythmia, ventricular remodelling and worse coronary collaterals flow, which can increase the incidence of major adverse cardiac event (MACE) after infarction. This study aimed to identify the role of fQRS as one of the risk factors for MACE (cardiac death and reinfarction) in acute coronary syndrome patients within 30 days observation. Methods: a cohort retrospective study was conducted using secondary data of acute coronary syndrome patients at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 to October 2017. Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors. Results: three hundred and fifty three (353) subjects were included. Fragmented QRS was found in 60,9 % subjects. It was more frequent in inferior leads (48.8% ) with mean onset of 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 fQRS group (RR 2.72; 95%CI 1.3 -5.71p=0.08). Multivariate analysis revealed adjusted RR of 2.79 (95% CI: 1.29 - 4.43, p<0.05). Low eGFR was a potential confounder in this study. Conclusion: persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and re-infarction.