Hasil Pencarian  ::  Simpan CSV :: Kembali

"Sindrom koroner akut (SKA) merupakan salah satu kegawatan kardiovaskular diInstalasi Gawat Darurat (IGD). Tatalaksana SKA yang ada saat ini membutuhkan waktuminimal 3 jam untuk menentukan apakah pasien dirawat atau dipulangkan, hal ini akanberdampak pada kepadatan IGD dan pemborosan biaya perawatan. European Society ofCardiology merekomendasikan algoritma 0/1 jam pada pasien dengan gambaran EKGnon elevasi segmen ST (NEST) dengan menggunakan high sensitive troponin T (hscTnT)dalam menegakkan atau penapisan infark miokard akut non elevasi segmen ST(IMA-NEST). Penelitian ini bertujuan untuk membandingkan nilai diagnostik hs-cTnTjam ke-1 dan jam ke-3 pada terduga SKA non elevasi segmen ST dengan awitan nyeridada kurang dari 6 jam. Desain penelitian potong lintang. Sebanyak 100 subjekpenelitian yang diambil secara konsekutif sampling. Sensitivitas, spesifisitas, nilaiprediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/1 jam secara berurutanadalah 93,75%, 98,81%, 93,75%, 98,81%, sementara sensitivitas, spesifisitas, nilaiprediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/3 jam secara berurutanadalah 87,50%, 96,81%, 93,33% 97,65%. Pemeriksaan hs-cTnT 0/1 jam dapatdipergunakan dalam rule in dan rule out terduga IMA-NEST dengan awitan nyeri dadakurang dari 6 jam.

---

Acute coronary syndrome (ACS) is one of the cardiovascular events in an EmergencyInstallation (ED). The patients management of ACS required at least 3 hours todetermined whether the patient hospitalized or outpatient, these would increased EDscrowded and high cost treatment. The European Society of Cardiology recommended a0/1 hour algorithm in patients with ECG showed non ST segment elevationusing highsensitive troponin T (hs-cTnT) parameter to rule in or rule out non ST segmentelevation myocard infarct (NSTEMI).We aimed to compare diagnostic values of hscTnTat the 1st and 3rd hour in NSTEMI with chest pain onset less than 6 hours. Studydesign was cross sectional. A total of 100 subjects enrolled by consecutive samplingmethod. Sensitivity, specificity, positive predictive value, and negative predictive valueof hs-cTnT 0/1 hours were 93.75%, 98.81%, 93.75%, 98.81%, while sensitivity,specificity, positive predictive value, and the negative predictive value of hs-cTnT 0/3hours were 87.50%, 96.81%, 93.33%, 97.65%. Hs-cTnT 0/1 hour test can be used inrule in and rule out suspect NSTEMI with the chest pain onset less than 6 hours."

"ABSTRAKLatar Belakang. IMA-EST merupakan salah satu manifestasi SKA yang fatal.Terapi reperfusi diindikasikan terhadap pasien dengan IMA-EST dengan awitankurang dari 12 jam. Perdarahan merupakan faktor resiko independen mortalitaspasca IKPP. Perdarahan mayor memperburuk prognosis, meningkatkan lamanyawaktu rawat dan meningkatkan biaya perawatan. Saat ini, penggunaan aksestrans-radial saat IKPP lebih diutamakan dan penghambat Gp2b3a tidak rutindigunakan. Walaupun demikian, kejadian perdarahan pada IMA-EST tetap sajameningkatkan tiga kali lipat resiko kematian. Sampai saat ini belum ada sistempenilaian khusus yang menilai resiko perdarahan pasca IKPP trans-radial.Metode. Penelitian kohort retrospektif dilaksanakan di Rumah Sakit PusatJantung dan Pembuluh Darah Nasional Harapan Kita. Data yang diambilmerupakan kasus IKPP trans-radial pada IMA-EST periode Januari 2011 ndash;Agustus 2016. Definisi perdarahan menggunakan definisi Bleeding AcademicResearch Consortium BARC . Pengolahan data dilakukan dengan analisisbivariat untuk menguji hubungan variabel-variabel independen dengan kejadianperdarahan, lalu dilakukan analisis multivariat. Pemilihan model akhir dilakukandengan metode backward selection dan dilakukan pembobotan untuk membentuksuatu sistem penilaian. Dilakukan validasi internal terhadap sistem penilaian inimenggunakan metode bootsrapping.Hasil. Sejumlah 1035 sampel dikumpulkan, 49 4.7 kasus di antaranyamengalami perdarahan. Didapatkan 6 faktor yang dapat dijadikan prediktorindependen terhadap kejadian perdarahan pasca IKPP trans-radial, yaitu : IMT 2, usia ge; 62 tahun, hitung leukosit ge; 12.000 10/ L,nilai hemoglobin Hb < 13 g/dL, dan nilai kreatinin ge; 1.5 mg/dL. Uji kalibrasidan validasi internal terhadap studi menunjukkan hasil yang baik.Kesimpulan. Sistem penilaian resiko perdarahan pasca IKPP trans-radial inimemiliki hasil uji kalibrasi, uji diskriminasi, dan validasi internal yang cukupbaik. Sistem penilaian ini diharapkan dapat digunakan sebagai salah satu strategipencegahan perdarahan pasca IKPP trans-radial pada kasus IMA-EST.

---

ABSTRACTBackground STEMI is a fatal manifestation of acute coronary syndrome.Reperfusion therapy is indicated for acute STEMI patient within less than 12hours rsquo onset of chest pain. Bleeding is an independent mortality risk as acomplication of primary PCI. Major bleeding worsens the prognosis, prolonglength of hospital stay, and increase the cost of care. Nowadays, trans radialaccess during primary PCI is a priority and the use of Gp2b3a inhibitor is nolonger used routinely. However, post primary PCI bleeding event nonethelesstripled the risk of death. Until now, there has been no system of assessments thatmeasure the risk of post primary PCI bleeding in specific trans radial accesspopulation.Method Data from 1035 post trans radial primary PCI STEMI patients enrolledfrom a cohort retrospective study performed in National Cardiovascular CenterHarapan Kita between January 2011 and August 2016. BARC bleeding definitionwas utilized to standardized the identification of bleeding events. Statisticalanalysis done by performing bivariate analysis to identify the relationship of eachvariables to the bleeding event, then multivariate analysis was done using logisticregression before the scoring system developed. Internal validation was performedby bootstrapping tecnique.Results 4.7 from 1035 sample experienced bleeding event. 6 factors related tobleeding event post trans radial primary PCI were identified BMI 18.5 kg m2,KILLIP class 2, age ge 62, WBC ge 12.000 10 3 L, hemoglobin 13 g dL, andcreatinine ge 1.5 mg dL. Calibration test and internal validation of this studyshowing good result.Conclusion This trans radial Primary PCI bleeding risk score has a good resultof calibration test, discrimination test, and internal validation. This scoring systemis expected to be applied as one of bleeding avoidance strategies in trans radialprimary PCI in STEMI patients."

"Latar Belakang : Pasien infark miokard akut dengan elevasi segmen ST IMAEST yang mengalami revaskularisasi dengan intervensi koroner perkutan primer IKPP dapat terjadi cedera reperfusi yang mempengaruhi prognosis. Penelitianpada model hewan menunjukkan ticagrelor melindungi jantung dari cederareperfusi, namun demikian belum ada penelitian pada manusia yang menguji halini. Tujuan : Membandingkan pengaruh antara ticagrelor dengan clopidogrelterhadap cedera reperfusi yang diukur melalui kadar puncak high sensitivetroponin T hs-cTnT pada pasien IMA-EST yang mengalami revaskularisasi. Metode : Penelitian ini merupakan penelitian eksperimental acak tersamar gandayang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita padabulan Agustus 2016 sampai November 2016. Pasien IMA-EST yang akanmenjalani IKPP dirandomisasi ke dalam dua kelompok yaitu kelompok yangmendapatkan loading ticagrelor 180 mg dilanjutkan dosis rumatan 2x90 mg danyang mendapatkan loading clopidogrel 600 mg dilanjutkan dosis rumatan 1x75mg sebelum IKPP. Dilakukan pemeriksaan hs-cTnT 8 jam pasca dilatasi balonkateter pertama. Hasil Penelitian : Terdapat total 60 subyek, 30 subyek kelompok ticagrelor dan30 subyek kelompok clopidogrel. Tidak ditemukan perbedaan bermakna antaraticagrelor dengan clopidogrel terhadap kadar puncak hs-cTnT 9026 5026 ng/Lvs 9329 4664 ng/L, nilai p 0,809. Kesimpulan : Ticagrelor tidak menyebabkan kadar puncak high sensitivetroponin T yang lebih rendah bila dibandingkan dengan clopidogrel pada pasienIMA-EST yang mengalami revaskularisasi.

---

Background : Reperfusion injury influence prognosis in ST elevation myocardialinfarction STEMI patients after primary percutaneous coronary intervention PPCI . Previous study on animal models showed that ticagrelor may haveprotective effect on the heart by reducing reperfusion injury. However, no studyon humans has ever been done to confirm this.

Aim : To compare the effect of ticagrelor with clopidogrel on reperfusion injurycalculated by peak high sensitive troponin T hs cTnT in STEMI patients whounderwent revascularization.

Methods : This was a randomized controlled trial done in NationalCardiovascular Center Harapan Kita from August 2016 to November 2016.STEMI patients who underwent PPCI was randomized to either ticagrelor loadingdose 180 mg with maintenance of 2x90 mg or clopidogrel loading dose 600 mgwith maintenance of 1x75mg group. Peak hs Troponin T was measured 8 hoursafter first balloon dilatation.

Results : Sixty subjects was included in the study, 30 subjects in the ticagrelorgroup and 30 subjects in the clopidogrel group. There were no difference betweenticagrelor vs clopidogrel on peak hs cTnT levels 9026 5026 ng L vs 9329 4664 ng L, p value 0,809.

Conclusion : Ticagrelor does not cause a lower peak high sensitive troponin Tlevel compared to clopidogrel in STEMI patients who underwentrevascularization."

"ABSTRAK Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanyalebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuahperangkat yang memiliki peran penting dalam prognosis mortalitas PJK. SkormACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.Informasi tersebut berguna dalam menentukan prioritas tindakan angiografikoroner. Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagaiprediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yangmengalami sindrom koroner akut (SKA). Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCMtahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan denganmenggunakan Receiver Operating Characteristic (ROC) curves dengan intervalkepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengancara menghitung sensitivitas, spesifisitas, RKP, dan RKN. Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%. Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGKstadium 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 mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, 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 mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, 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 mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, 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 mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, 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."

"Latar Belakang: Disfungsi diastolik signifikan (derajat 2 dan 3) merupakan komplikasi yang relatif sering ditemukan dan prediktor mortalitas independen pada sindrom koroner akut (SKA). Pemeriksaan ekokardiografi untuk evaluasi disfungsi diastolik tidak selalu dapat dilakukan dan tidak tersedia luas di berbagai tingkat fasilitas pelayanan kesehatan. Pemeriksaan elektrokardiogram (EKG) lebih luas tersedia dan telah ditunjukkan pada penelitian sebelumnya memiliki nilai diagnostik sebagai skrining disfungsi diastolik pada pasien hipertensi dan penyakit ginjal kronikTujuan: Tujuan penelitian ini untuk menilai apakah parameter EKG waktu puncak gelombang P (PWPT) dan waktu dari puncak hingga akhir gelombang T (Tp-e) dapat digunakan sebagai skrining disfungsi diastolik signifikan pada pasien sindrom koroner akut.Metode: Data sekunder (ekokardiogram dan EKG yang diperiksakan pada hari yang sama) dari 93 pasien SKA yang dirawat di ruang rawat intensif koroner dari Januari 2020 hingga Januari 2021 dianalisis dalam studi cross-sectional ini. PWPTV1 didefinisikan sebagai waktu dari awal gelombang P hingga mencapai puncaknya (diukur di sandapan V1). Tp-e didefinisikan sebagai waktu dari puncak gelombang T hingga akhir gelombang T (diukur di V5). Peneliti yang menilai EKG tidak mengetahui hasil ekokardiogram (blinding). Parameter EKG dan variabel lain dibandingkan di antara grup SKA dengan dan tanpa disfungsi diastolik signifikan.Hasil: Terdapat 32,3% pasien SKA dengan disfungsi diastolik signifikan. Durasi PWPTV1 memanjang pada kelompok SKA dengan disfungsi diastolik signifikan (65 vs. 59 miliseconds, p<0.01). PWPTV1 memiliki korelasi dengan indeks volume atrium kiri (LAVI) (r=0,283, p=0,019) and merupakan prediktor independen terhadap disfungsi diastolik signifikan (OR=1,062, p=0,035). Sebaliknya Tp-e tidak didapatkan memilki perbedaan signifikan diantara kedua kelompok dan tidak berkorelasi dengan parameter disfungsi diastolik pada ekokardiografi. Analisis receiver operating characteristics (ROC) PWPTV1 menunjukkan AUC=0,677 (IK 95% 0.557-0,798), p=0,006 dengan titik potong optimal di 63,5 milidetik yang menunjukkan sensitivitas 60% dan spesifisitas 77,8 persen.Simpulan: Hasil penelitian ini menunjukkan pemanjangan PWPTV1 memiliki nilai diagnostik yang rendah untuk skrining disfungsi diastolik signifikan pada pasien sindrom koroner akut.

---

Background: Significant diastolic dysfunction (grade 2 and 3) is a relatively common complication and an independent predictor of mortality in acute coronary syndrome (ACS). Evaluation of diastolic function by echocardiography is not always feasible and accessible throughout all levels of healthcare facilities. Electrocardiogram (ECG) test is more readily available and has been shown in previous studies to have a diagnostic value to screen for diastolic dysfunction in hypertensive and chronic kidney disease (CKD) patients.

Objective: The purpose of this study is to examine whether ECG indices P wave peak time (PWPT) and T wave peak to T wave end (Tp-e) can be used as an aid to screen for significant diastolic dysfunction in patients with acute coronary syndrome.

Methods: Secondary data (echocardiogram and ECG on the same day) of 93 ACS patients admitted to the intensive coronary care unit (ICCU) from January 2020 to January 2021 were analyzed in this cross-sectional study. PWPTV1 was defined as the time from begining of P wave to its peak (meassured in lead V1). Tp-e was defined as the time from begining of T wave peak to its end (meassured preferably in lead V5). ECG evaluator was blinded to the echocardiogram results. ECG indices and other variables were compared between groups of ACS patients with and without significant diastolic dysfunction.

Results: Significant diastolic dysfunction was present in 32,3% of ACS patients. PWPTV1 was significantly prolonged in the significant diastolic dysfunction group (65 vs. 59 miliseconds, p<0.01). PWPTV1 has significant correlation with left atrial volume index (LAVI) (r=0,283, p=0,019) and was found to be an independent predictor of significant diastolic dysfunction (OR=1,062, p=0,035). Tp-e on the other hand showed no difference between the two groups and was not correlated with echocardiography diastolic dysfunction indices. Receiver operating characteristics (ROC) analysis of PWPTV1 showed AUC=0,677 (IK 95% 0.557-0,798), p=0,006 with optimal cut off point of 63,5 miliseconds which showed 60% sensitivity and 77,8% specificity.

Conclusion: In this study prolonged PWPTV1 was shown to have low diagnostic value to screen for significant diastolic dysfunction in ACS patients"

"Sindrom koroner akut (SKA) merupakan masalah kesehatan nasional karena tingginya angka morbiditas dan mortalitas serta beban biaya yang dibutuhkan. Intervensi koroner perkutan (IKP) dan terapi antiplatelet seperti klopidogrel merupakan tata laksana yang direkomendasikan oleh organisasi kardiologi internasional. Meskipun demikian, pasien SKA masih dapat mengalami kejadian kardiovaskular mayor (KKM). Kemungkinan, resistensi klopidogrel berperan pada KKM sedangkan resistensi klopidogrel mungkin dipengaruhi oleh faktor genetik dan epigenetik. Penelitian ini bertujuan untuk mengetahui hubungan faktor genetik yaitu polimorfisme gen CYP2C19 dan P2Y12, serta epigenetik yaitu metilasi DNA gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dengan resistensi klopidogrel dan pengaruhnya terhadap KKM pada pasien SKA pasca IKP.Untuk menganalisis hubungan faktor genetik dan epigenetik dengan resistensi klopidogrel, penelitian dilakukan dengan desain potong lintang, sedangkan untuk analisis hubungan faktor genetik dan epigenetik dengan KKM dilakukan dengan desain kohort prospektif. Subjek penelitian meliputi 201 pasien SKA pasca IKP dan mendapat terapi klopidogrel di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2018 sampai dengan Juni 2020. Resistensi klopidogrel ditentukan dengan pemeriksaan light transmission aggregometry (LTA) apabila hasilnya lebih besar dari 59% dengan agonis ADP 20 mM. Deteksi polimorfisme gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dilakukan dengan metode qRT-PCR, sedangkan metilasi DNA gen CYP2C19 dan P2Y12 dikerjakan dengan metode konversi bisulfit. Pasien diobservasi selama satu tahun dan jika ada angina pektoris, infark miokard akut (IMA) rekuren, stroke, atau kematian, dicatat sebagai KKM.Dari 201 subjek, terdapat 45,8% carrier mutant polimorfisme *2 dan *3 gen CYP2C19, 36,8% carrier mutant polimorfisme rs3679479 gen P2Y12, 10% hipometilasi DNA gen P2Y12, 80,1% hipometilasi DNA gen CYP2C19, dan 66,2% ekspresi miRNA-26a up regulated. Proporsi resisten klopidogrel adalah 49,8% dan proporsi KKM adalah 14,9% (kematian 7,5%). Terdapat hubungan antara merokok (p = 0,001; OR 0,37 [IK 95%; 0,20–0,68]), hipometilasi DNA gen CYP2C19 (p = 0,037; OR 2,13 [IK 95%; 1,04–4,37]), dan ekspresi miRNA-26a up regulated (p = 0,020; OR 2,03 [IK 95%; 1,12–3,68]) dengan resistensi klopidogrel. Terdapat hubungan antara jenis kelamin perempuan (p = 0,040; HR 2,73 [IK 95%; 1,05–7,14]), usia ≥ 60 tahun (p = 0,035; HR 2,17 [IK 95%; 1,06–4,48]), eGFR rendah (p = 0,001; HR 3,29 [IK 95%; 1,59–6,84]), dan polimorfisme *2 dan *3 gen CYP2C19 (p = 0,047; HR 2,12 [IK 95%; 1,01–4,46]) dengan KKM dalam satu tahun.Hanya faktor epigenetik berupa metilasi DNA gen CYP2C19 dan ekspresi miRNA-26a yang berhubungan dengan resistensi klopidogrel. Walaupun resistensi klopidogrel tidak berhubungan dengan KKM, terdapat hubungan antara faktor genetik polimorfisme *2 dan *3 gen CYP2C19 dengan KKM.

---

Acute coronary syndrome (ACS) is a national health problem due to high morbidity and mortality, and cost burden as well. Percutaneous coronary intervention (PCI) and antiplatelet therapy such as clopidogrel are recommended. However, ACS patients could still experience major adverse cardiovascular events (MACE). Clopidogrel resistance possibly plays a role in MACE whereas it may be affected by genetic and epigenetic factors. Therefore, the objective of this study was to determine the relationship between genetic factors which are CYP2C19 and P2Y12 polymorphisms, as well as epigenetic factors which are DNA methylation of CYP2C19 and P2Y12, and miRNA-26a expression and their effects on MACE in post-PCI patients.

To analyze the association between genetic and epigenetic factors and clopidogrel resistance, the study design was cross-sectional, while the study design of relationship between genetic and epigenetic factors and MACE was prospective cohort. The subjects were 201 post-PCI ACS patients who received clopidogrel therapy at Harapan Kita Hospital from September 2018 to June 2020. Clopidogrel resistance was determined by light transmission aggregometry (LTA) if the result was greater than 59% with agonist ADP 20 µM. The detection of CYP2C19 and P2Y12 gene polymorphisms and miRNA-26a expression were carried out by qRT-PCR method, while the DNA methylation of the CYP2C19 and P2Y12 genes were carried out by bisulfite conversion method. Patients were observed for one year and angina pectoris, recurrent acute myocardial infarction (AMI), stroke, or death, were recorded as MACE.

From 201 subjects, 45.8% were CYP2C19*2 and CYP2C19*3 polymorphism mutant carrier, 36.8% were rs3679479 P2Y12 polymorphism mutant carrier, 10% were hypomethylated of P2Y12, 80.1% were hypomethylated of CYP2C19, and 66.2% were up regulated in miRNA-26a expression. 49.8% of subjects were clopidogrel resistant and 14.9% of subjects experienced MACE (death was 7.5%). Smoking (p = 0.001; OR 0.37 [CI 95%; 0.20–0.68]), hypomethylated of CYP2C19 (p = 0.037; OR 2.13 [CI 95%; 1.04–4.37]), and up regulated miRNA-26a expression (p = 0.020; OR 2.03 [CI 95%; 1.12–3.68]) were associated with clopidogrel resistance. Female gender (p = 0.040; HR 2.73 [CI 95%; 1.05–7.14]), age over 60 years old (p = 0.035; HR 2.17 [CI 95%; 1.06–4.48]), low eGFR (p = 0.001; HR 3.29 [CI 95%; 1.59–6.84]), and CYP2C19*2 and CYP2C19*3 polymorphisms (p = 0.047; HR 2.12 [CI 95%; 1.01–4.46]) were associated with MACE in one year.

Only DNA methylation of CYP2C19 and miRNA-26a expression were associated with clopidogrel resistance. Although clopidogrel resistance was not associated with MACE, there was association between CYP2C19*2 and CYP2C19*3 polymorphisms and MACE."

"ABSTRAK Diagnosis infark miokard akut ditegakkan apabila memenuhi 2 dari 3 kriteria, yaitu klinis, perubahan EKG, dan peningkatan kadar penanda biokimia jantung. Troponin merupakan penanda biokimia jantung yang spesifik untuk infark miokard, akan tetapi memiliki keterbatasan yaitu kurang sensitif apabila dilakukan pada fase awal karena troponin akan meningkat dalam darah setelah 4 -10 jam setelah infark miokard. Copeptin merupakan penanda stres endogen, yang dapat meningkat pada awal onset infark miokard akut, namun kurang spesifik. Penelitian tentang copeptin-us sebagai penanda biokimia jantung masih sedikit dan di Indonesia penelitian tentang copeptin-us sebagai penanda biokimia jantung belum pernah dilakukan.Penelitian ini mengikutsertakan 91 pasien tersangka sindrom koroner akut yang terbagi atas 15 (16,5%) NSTEMI, 43 (47,3%) UA, dan 33 (36,3%) non SKA. Diagnosis ditegakkan oleh dokter di IGD RS Jantung dan Pembuluh Darah Harapan Kita. Karakteristik pasien yang memenuhi kriteria inklusi dan eksklusi dicatat dan kemudian dilakukan pemeriksaan copeptin-us.Nilai rerata copeptin-us pada NSTEMI adalah 151,80 ± 130,03 pmol/L, median copeptin-us pada UA adalah 7,12(1,145 ? 62,23) pmol/L, dan rerata copeptin-us pada non SKA adalah 7,36 ± 4,17 pmol/L. Nilai cut off copeptin-us untuk membedakan NSTEMI dengan UA/non SKA adalah 13,97 pmol/L. Area under curve (AUC) kombinasi hs-cTnT saat masuk rumah sakit dengan copeptin-us adalah 0,941 (0,882 ? 1,00), hs-cTnT saat masuk rumah sakit 0,885 (0,790 ? 0,98), dan AUC hs-cTnT 3 jam kemudian adalah 0,925 (0,824 ? 1,00). Nilai median hs-cTnT saat masuk RS pada NSTEMI adalah 114(29-1102) pg/mL, pada UA adalah 16 (3-3352) pg/mL, dan pada non SKA adalah 6(3-366) pg/mL. Nilai median hs-cTnT 3 jam pada NSTEMI adalah 488 (81-18437) pg/mL, pada UA 14(3-2224) pg/mL, dan pada non SKA adalah 3(3-679) pg/mL. Kombinasi copeptin-us ≥ 13,97 pmol/L dan hs-cTnT ≥ 14 pg/mL dan untuk membedakan NSTEMI dengan UA/non SKA memberikan sensitivitas 100%, spesifisitas 90,78%, NPP 68,18%, dan NPN 100%.Uji diagnostik kombinasi copeptin-us dan hs-cTnT saat masuk RS lebih baik dibandingkan hs-cTnT saat masuk RS saja dan dapat digunakan untuk rule out NSTEMI.ABSTRACT Diagnosis of acute myocardial infarction is made when two of the followed criterias are met; clinical, ECG changes, and increased levels of cardiac biochemical markers. Troponin is a specific cardiac biochemical marker for myocardial infarction but has limitation. It is less sensitive when measured in the early phase, because troponin will increase in blood after 4 -10 hours post myocardial infarction. Copeptin is an endogenous stress marker, it level increases in the early onset of acute myocardial infarction but study on copeptin-us as cardiac biochemical marker are limited and in Indonesia there is no study on copeptin-us has been done.In this study 91 consecutive patients fulfilled the inclusion and exclusion criteria, consist of 15 (16,5%) NSTEMI, 43 (47,3%) unstable angina, and 33 (36,3%) non acute coronary syndrome. Diagnosis was made by the emergency physician at Harapan Kita cardiovascular centre. Characteristics of these subject were recorded and then the copeptin-us levels were measured.The mean value of copeptin-us in NSTEMI is 151,80 ± 130,03 pmol/L, median copeptin-us in UA is 7,12(1,145 ? 62,23) pmol/L, and the mean copeptin-us in non ACS is 7,36 ± 4,17 pmol/L. Cut off value of copeptin-us to distinguish NSTEMI from UA/non ACS is 13,97 pmol/L. Area under curve of the combination hs-cTnT on admission and copeptin-us is 0,941 (0,882 ? 1,00), hs-cTnT on admission is 0,885 (0,790 ? 0,98), and hs-cTnT 3 hours laters is 0,925 (0,824 ? 1,00). Median value hs-cTnT on admission in NSTEMI is 114(29-1102) pg/mL, in UA is 16 (3-3352) pg/mL, and in non ACS is 6(3-366) pg/mL. Median hs-cTnT 3 hours in NSTEMI is 488(81-18437) pg/mL, in UA is 14(3-2224) pg/mL, and in non ACS is 3(3-679) pg/mL. Combination of copeptin-us ≥ 13,97 pmol/L and hs-cTnT ≥14 pg/mL to distinguish NSTEMI from UA/non ACS has sensitivity 100%, specificity 90,78%, PPV 68,18%, and NPV 100%.The diagnostic value of combination on copeptin-us and hs-cTnT is better than only hs-cTnT on admission so that it can be used to rule out NSTEMI.;Diagnosis of acute myocardial infarction is made when two of the followed criterias are met; clinical, ECG changes, and increased levels of cardiac biochemical markers. Troponin is a specific cardiac biochemical marker for myocardial infarction but has limitation. It is less sensitive when measured in the early phase, because troponin will increase in blood after 4 -10 hours post myocardial infarction. Copeptin is an endogenous stress marker, it level increases in the early onset of acute myocardial infarction but study on copeptin-us as cardiac biochemical marker are limited and in Indonesia there is no study on copeptin-us has been done.In this study 91 consecutive patients fulfilled the inclusion and exclusion criteria, consist of 15 (16,5%) NSTEMI, 43 (47,3%) unstable angina, and 33 (36,3%) non acute coronary syndrome. Diagnosis was made by the emergency physician at Harapan Kita cardiovascular centre. Characteristics of these subject were recorded and then the copeptin-us levels were measured.The mean value of copeptin-us in NSTEMI is 151,80 ± 130,03 pmol/L, median copeptin-us in UA is 7,12(1,145 ? 62,23) pmol/L, and the mean copeptin-us in non ACS is 7,36 ± 4,17 pmol/L. Cut off value of copeptin-us to distinguish NSTEMI from UA/non ACS is 13,97 pmol/L. Area under curve of the combination hs-cTnT on admission and copeptin-us is 0,941 (0,882 ? 1,00), hs-cTnT on admission is 0,885 (0,790 ? 0,98), and hs-cTnT 3 hours laters is 0,925 (0,824 ? 1,00). Median value hs-cTnT on admission in NSTEMI is 114(29-1102) pg/mL, in UA is 16 (3-3352) pg/mL, and in non ACS is 6(3-366) pg/mL. Median hs-cTnT 3 hours in NSTEMI is 488(81-18437) pg/mL, in UA is 14(3-2224) pg/mL, and in non ACS is 3(3-679) pg/mL. Combination of copeptin-us ≥ 13,97 pmol/L and hs-cTnT ≥14 pg/mL to distinguish NSTEMI from UA/non ACS has sensitivity 100%, specificity 90,78%, PPV 68,18%, and NPV 100%.The diagnostic value of combination on copeptin-us and hs-cTnT is better than only hs-cTnT on admission so that it can be used to rule out NSTEMI.;Diagnosis of acute myocardial infarction is made when two of the followed criterias are met; clinical, ECG changes, and increased levels of cardiac biochemical markers. Troponin is a specific cardiac biochemical marker for myocardial infarction but has limitation. It is less sensitive when measured in the early phase, because troponin will increase in blood after 4 -10 hours post myocardial infarction. Copeptin is an endogenous stress marker, it level increases in the early onset of acute myocardial infarction but study on copeptin-us as cardiac biochemical marker are limited and in Indonesia there is no study on copeptin-us has been done.In this study 91 consecutive patients fulfilled the inclusion and exclusion criteria, consist of 15 (16,5%) NSTEMI, 43 (47,3%) unstable angina, and 33 (36,3%) non acute coronary syndrome. Diagnosis was made by the emergency physician at Harapan Kita cardiovascular centre. Characteristics of these subject were recorded and then the copeptin-us levels were measured.The mean value of copeptin-us in NSTEMI is 151,80 ± 130,03 pmol/L, median copeptin-us in UA is 7,12(1,145 ? 62,23) pmol/L, and the mean copeptin-us in non ACS is 7,36 ± 4,17 pmol/L. Cut off value of copeptin-us to distinguish NSTEMI from UA/non ACS is 13,97 pmol/L. Area under curve of the combination hs-cTnT on admission and copeptin-us is 0,941 (0,882 ? 1,00), hs-cTnT on admission is 0,885 (0,790 ? 0,98), and hs-cTnT 3 hours laters is 0,925 (0,824 ? 1,00). Median value hs-cTnT on admission in NSTEMI is 114(29-1102) pg/mL, in UA is 16 (3-3352) pg/mL, and in non ACS is 6(3-366) pg/mL. Median hs-cTnT 3 hours in NSTEMI is 488(81-18437) pg/mL, in UA is 14(3-2224) pg/mL, and in non ACS is 3(3-679) pg/mL. Combination of copeptin-us ≥ 13,97 pmol/L and hs-cTnT ≥14 pg/mL to distinguish NSTEMI from UA/non ACS has sensitivity 100%, specificity 90,78%, PPV 68,18%, and NPV 100%.The diagnostic value of combination on copeptin-us and hs-cTnT is better than only hs-cTnT on admission so that it can be used to rule out NSTEMI."

"Latar Belakang: Penyakit kardio-serebrovaskular dengan kematian tertinggi sebagian besar diakibatkan Sindroma Koroner Akut (SKA). Dalam perjalanan penyakit tersebut dapat timbul gangguan psikis berupa depresi. Dilaporkan bahwa depresi sering terjadi dan menetap, dengan prevalensi sekitar 20% pada pasien dengan penyakit jantung. Gangguan psikis memiliki hubungan yang erat dengan pengaruh hormonal seperti kortisol dan serotonin. Pada pasien SKA dapat terjadi disfungsi otonom dan disregulasi aksis HPA yang menyebabkan peningkatan kortisol yang dapat memperburuk prognosispasien SKA. Sehingga penting untuk mengetahui pengaruh hormonal yaitu kadar kortisoldan serotonin dalam mengurangi gejala depresi yang akan ditelaah pada penelitian ini. Metode: Penelitian ini merupakan penelitian cross sectional untuk mengetahui peran kortisol dan serotonin terhadap kejadian depresi pada pasien SKA pasca perawatan. Penelitian dilakukan di ICCU RSUPN dr. Cipto Mangunkusumo Jakarta Pusat, Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM dan Divisi Psikosomatik danPaliatif Departemen Ilmu Penyakit Dalam FKUI/RSCM pada 73 orang responden yang memenuhi kriteria inklusi dengan menggunakan wawancara, pengisian kuesioner HADS,pemeriksaan fisik, dan pemeriksaan laboratorium. Hasil: Sebanyak 15,1% pasien SKA mengalami depresi pasca perawatan. Hasil uji statistik antara serotonin plasma terhadapdepresi tidak bermakna secara statistik dengan p value 0,482, demikian pula dengan kortisol saliva dengan p value 0,275. Namun ditemukan bahwa, kadar rerata hormon serotonin pada pasien SKA dalam penelitian ini adalah 189 ng/ml dan kadar rerata kortisol pada pasien SKA pada penelitian ini adalah 2,19 ng/mL. Kesimpulan: Secara statistik, tidak ditemukan perbedaan signifikan antara kadar kortisol terhadap gejala depresi pada pasien paska sindrom koroner akut dengan nilai p-value 0,275. Namun, penelitian ini bermakna secara klinis dilihat dari kadar serotonin plasma yang lebih rendah pada pasien dengan depresi dan lebih tinggi pada pasien yang tidak depresi. Begitu pula dengan kadar kortisol saliva lebih tinggi pada pasien dengan depresi dan lebih rendah pada pasien yang tidak depresi.

---

Background: Cardio-cerebrovascular disease with the highest mortality is mostly due toAcute Coronary Syndrome (ACS). During the course of the disease, psychological disorders such as depression may happen. It has been reported that depression is commonand persistent, with a prevalence of approximately 20% in patients with heart disease. Psychological disorders have a close relationship with hormones such as cortisol and serotonin. In ACS patients, autonomic dysfunction and dysregulation ofthe HPA axis canoccur and cause an increase in cortisol which can worsen the prognosis of ACS patients. So it is important to know the how hormones, namely cortisol and serotonin in reducing depressive symptoms which will be examined in this study. Methods: This study is a cross-sectional study to determine the impact of cortisol and serotonin in the incidence ofdepression in post-treatment ACS patients. The research was conducted at the ICCU RSUPN dr. Cipto Mangunkusumo Central Jakarta, Division of Cardiology Department ofInternal Medicine FKUI/RSCM and Division of Psychosomatics and Palliative Department of Internal Medicine FKUI/RSCM in 73 respondents who met the inclusion criteria by using interviews, filling out HADS questionnaires, physical examinations andlaboratory tests. Results: A total of 15.1% of ACS patients experienced post-treatment depression. The statistical test results between plasma serotonin and depression were notstatistically significant with a p value of0.482, as well as salivary cortisol with a p valueof 0.275. However, it was found that the average serotonin level in ACS patients in this study was 189 ng/ml and the average cortisol level in ACS patients in this study was 2.19 ng/mL. Conclusion: Statistically, there was no significant relationship between cortisol levels and depressive symptoms in post-acute coronary syndrome patients with a p-valueof 0.275. However, this study is clinically significant in view of the lower plasma serotonin levels in patients with depression and higher in patients who are not depressed.Likewise, salivary cortisol levels were higher in patients with depression and lower in patients who were not depressed."

"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. "

"ABSTRAKNama : Anditha RatnadhiyaniProgram Studi : Magister Ilmu KeperawatanJudul : Pengalaman Wanita Pasca Sindrom Koroner Akut dalam Adaptasi terhadap Perubahan Kemampuan Fungsional Pemulihan pasca sindrom koroner akut mencakup proses adaptasi individu terhadap perubahan kemampuan fungsional. Perkembangan dalam penelitian di bidang kardiovaskular menunjukkan dampak dan prognosis sindrom koroner akut yang lebih buruk pada wanita jika dibanding pria, yang dikaitkan dengan perbedaan dalam persepsi, prediktor klinis, dan status sosioekonomi. Penelitian ini bertujuan untuk mengeksplorasi pengalaman wanita pasca sindrom koroner akut dalam adaptasi terhadap perubahan kemampuan fungsional. Metode kualitatif dengan desain fenomenologi deskriptif digunakan untuk memperoleh gambaran pengalaman sepuluh partisipan dalam penelitian ini. Pengambilan data dilakukan dengan wawancara mendalam, kemudian dilakukan content analysis dengan metode Colaizzi. Teridentifikasi enam tema utama dari penelitian ini yaitu respon ketidaknyamanan setelah mengalami sindrom koroner akut, penurunan kemandirian dan kemampuan melakukan aktivitas sebagai dampak perubahan kondisi fisik, self-adjustment sebagai koping terhadap perubahan kemampuan fisik, revaskularisasi memberikan harapan kesembuhan, pengaruh dukungan terhadap psikologis, dan self-effort untuk memulihkan kemampuan fungsional. Hasil penelitian menunjukkan peran penting faktor psikologis dalam proses adaptasi wanita selama pemulihan, sehingga direkomendasikan peningkatan intervensi yang mendukung psikologis dalam tatalaksana pasien wanita dengan sindrom koroner akut. Kata kunci: adaptasi, kemampuan fungsional, sindrom koroner akut, wanita

---

ABSTRACTName Anditha RatnadhiyaniStudy Program Master of NursingTitle The Experiences of Women after Acute Coronary Syndrome in Adaptation to Functional Ability Changes Adaptation to functional ability changes is part of recovery after Acute Coronary Syndrome ACS . Earlier studies have indicated that women with ACS have worse impact and prognosis. It is associated with perception differences, clinical predictors and socio economy status. The aim of this study is to explore experiences of women after ACS in adaptation to functional ability changes. A qualitative study using phenomenological description design was conducted. Ten women after ACS participated in individual in depth interview. Data were analysed using Colaizzi rsquo s procedural approach. Women rsquo s experiences in adaptation were formulated into six main themes 1 inconvenience response to ACS 2 decrease in autonomy and ability to perform activities as a result of physical changes 3 self adjustment as a mechanism to cope with physical ability changes 4 being recovered by revascularization 5 social support promotes psychological improvement and 6 self efforts to improve functional abilities. This research denotes a major role of psychological factors in women rsquo s adaptation during recovery process. Therefore, developing a psychological based intervention for women after ACS is an important strategy to improve outcomes. Keywords acute coronary syndrome, adaptation, functional ability, women"