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"Latar belakang : Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya mortalitas pada pasien ST-Elevasi Miokard Infark (STEMI) yang menjalani intervensi koroner perkutan primer (IKPP). Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE selama perawatan diharapkan dapat meningkatkan perawatan dan luaran klinis dari pasien STEMI. Penelitian ini bertujuan untuk mengetahui faktor prediktor MACE selama perawatan pada pasien STEMI yang dilakukan IKPP di RSCM.Metode : Studi kohort retrospektif dengan menelusuri rekam medis pasien yang menjalani IKPP di RSCM periode Januari 2015-Maret 2020. Dilakukan analisa bivariat antara faktor prediktor usia, status merokok, hipertensi, diabetes mellitus, penyakit ginjal kronik, time-to-treatment, kelas killip, fraksi ejeksi ventrikel kiri (FEVK) dan kadar kolesterol LDL dengan kejadian MACE selama perawatan pada pasien STEMI yang menjalani IKPP, menggunakan metode Chi-square. Analisa multivariat dan analisa model prediksi dilakukan dengan metode regresi logistik terhadap variabel dengan nilai p= <0,25 pada analisa bivariat.Hasil : Didapatkan subyek sebanyak 291 pasien untuk diteliti. Major Adverse Cardiac Events selama perawatan didapatkan sebesar 43,3% dengan usia >60 tahun (29,6%), status merokok (61,2%), hipertensi (50,9%), diabetes mellitus (36.1%), penyakit ginjal kronik (6,2%), kelas Killip II-IV (32,2%), FEVK > 50% (57%) dan kadar kolesterol LDL > 100 mg/dl (79,4%). Median time-to-treatment didapatkan sebesar 528 (379-730) menit. Usia, kelas killip dan FEVK mempengaruhi kejadian MACE selama perawatan dengan OR (IK 95%) masing-masing 2,15 (1,22-3,79), 4,34 (2,49-7,56) dan 2,88 (1,72-4,82). Model prediksi MACE selama perawatan pada pasien STEMI yang menjalani IKPP memiliki nilai area under curve (AUC) 0,729 (IK 95% 0,67-0,78).Kesimpulan : Major Adverse Cardiac Events (MACE) selama perawatan pada pasien STEMI yang menjalani IKPP sebesar 43,3%, yang dipengaruhi oleh usia, kelas killip dan FEVK.

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Introduction: Major Adverse Cardiac Events (MACE) is the main causes to increase mortality on ST-Elevation Myocardial Infarction (STEMI) patients who undergo Primary Percutaneous Coronary Intervention (PPCI). In-hospital MACE inducing factor predictors identification is expected to enhance STEMI patients’ care and outcome. This study aims to identify in-hospital MACE factor predictors on STEMI patients with PPCI treatment at RSCM.

Method: Restropective cohort study by tracing medical record on patients with PPCI treatment at RSCM during January 2015 - March 2020. Chi-squared bivariate analysis concluded between predictor factors; age, smoking, hypertension, diabetic mellitus, chronic kidney disease, time-to-treatment, killip class, left ventricle ejection fraction (LVEF) and LDL cholesterol level. Logistic regression is used on multivariat and prediction model analysis on variables with p=<0,25 in bivariate analysis.

Result: This study involves 291 patient subjects. During this study, the occurance of MACE is 43.3% on patients age > 60 years (29,6%), smoking (61,2%), hypertension (50,9%), diabetes mellitus (36,1%), chronic kidney disease (6,2%), killip class II-IV (32,2%), LVEF > 50% (57%) dan cholesterol LDL level > 100 mg/dl (79,4%). Median time-to-treatment is 528 (379-730) minutes. Age, killip class, and LVEF influences in-hospital MACE during PPCI with OR (95% CI) consecutively are 2,15 (1,22-3,79), 4,34 (2,49-7,56) and 2,88 (1,72-4,82). MACE prediction model in this study produces area under curve (AUC) 0,729 (95% CI 0,67-0,78).

Conclusion: In-hospital MACE on STEMI patient after PPCI occurance is 43.3%, influenced by age, killip class, and LVEF."

"Latar belakang: Populasi usia lanjut dengan penyakit jantung koroner yang menjalani tindakan intervensi koroner perkutan (IKP) menunjukkan tren meningkat. Di sisi lain, kelompok usia lanjut juga dihadapkan dengan major adverse cardiac events pasca tindakan IKP. Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE 30 hari diharapkan dapat menjadi sarana stratifikasi risiko pratindakan, meningkatkan luaran klinis serta menjadi pertimbangan pemilihan strategi intervensi pada pasien PJK usia lanjut.Tujuan: Mengetahui insidens MACE 30 hari, faktor prediktor MACE 30 hari pada pasien PJK usia lanjut yang menjalani tindakan IKP, dan pengembangan model prediksi MACE 30 hari.Metode: studi kohort retrospektif dengan menulusuri rekam medis pasien usia lanjut yang menjalani IKP di RSCM periode Januari 2017-Desember 2021. Dilakukan analisis bivariat chi-square antara faktor usia, jenis kelamin, hiperglikemia saat admisi, kreatinin serum, kelas Killip, status fungsional, status nutrisi, status frailty, dan jenis PJK dengan kejadian MACE 30 hari pascatindakan IKP. Analisis multivariat dan model prediksi dilakukan dengan metode regresi logistik.Hasil: Terdapat 616 subjek penelitian untuk diteliti. Insidens MACE 30 hari pada pasien PJK usia lanjut sebesar 5,4%. Hasil analisis bivariat menunjukkan adanya hubungan antara faktor hiperglikemia saat admisi, kelas Killip, status fungsional, status nutrisi, dan jenis PJK dengan kejadian MACE 30 hari (p<0,05). Hasil regresi logistik menunjukkan Kelas Killip dan jenis PJK merupakan faktor prediktor independen terjadinya MACE 30 hari dengan adjusted OR 8,841 (IK95% 3,339-23,410) untuk kelas Killip dan adjusted OR 3,774 (1,365-10,426) untuk PJK. Model prediksi MACE 30 hari memiliki nilai AUC 0,7995 (IK95% 0,712-0,886)Kesimpulan: MACE 30 hari pada pasien PJK usia lanjut yang menjalani IKP sebesar 5,4% dengan faktor prediktor independen kelas Killip dan jenis PJK.

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Background: The elderly with coronary heart disease undergoing percutaneous coronary intervention (PCI) shows an increasing trend. On the other hand, the elderly group is also faced with major adverse cardiac events after PCI. Identification of predictors that influence the occurrence of 30-day MACE is expected to be a means of preprocedural risk stratification, improve clinical outcomes and become a consideration for selecting intervention strategies in elderly CHD patients.

Objectives: To determine the incidence of 30-day MACE, the predictors of 30-day MACE in elderly CHD patients undergoing PCI, and the development of 30-day MACE prediction model.

Methods: Retrospective cohort study by reviewing medical records of elderly patients undergoing PCI at RSCM for the period January 2017-December 2021. Chi-square bivariate analysis was performed between predictors of age, sex, hyperglycemia at admission, serum creatinine, Killip class, functional status, nutritional status, frailty status, and type of CHD with MACE events 30 days after PCI. Multivariate analysis and prediction models were performed using the logistic regression.

Results: There were 616 research subjects to be studied. The incidence of 30-day MACE in elderly CHD patients was 5.4%. The results of bivariate analysis showed a relationship between hyperglycemia at admission, Killip class, functional status, nutritional status, and type of CHD with 30-day MACE (p<0.05). Logistic regression results showed Killip class and CHD type were independent predictors of 30-day MACE with adjusted OR 8.841 (95%CI 3.339-23.410) for Killip class and adjusted OR 3,774 (1.365-10.426) for type of CHD. The 30-day MACE prediction model has an AUC value of 0.7995 (95%CI 0.712-0.886)

Conclusion: Incidence of 30-day MACE in elderly with CHD undergoing PCI is 5.4% with Killip class and type of CHD as independent predictor factors."

"[ABSTRAKLatar Belakang: Major adverse cardiac events (MACE) merupakan komplikasi serius pada pasien pasca sindrom koroner akut (SKA) sehingga perlu suatu metode yang andal dalam memprediksi kejadiannya. Heart rate variability (HRV) yang menggambarkan ketidakseimbangan sistem otonom pasca SKA dan dapat dilakukan dengan cara yang lebih cepat, mudah, dan praktis berpotensi dapat digunakan sebagai alat stratifikasi risiko MACE.Tujuan: Mengetahui kemampuan HRV awal perawatan yang diukur melalui metode pulse photoplethysmograph (PPG) dalam memprediksi MACE pada pasien pasca SKA yang dirawat di intensive cardiac care unit (ICCU).Metode: Studi ini adalah studi kohort prospektif dengan subjek pasien SKA yang menjalani perawatan di ICCU. Pemeriksaan HRV dilakukan dengan metode PPG dalam 48 jam pasca diagnosis SKA dan adanya MACE dideteksi selama perawatan di ICCU. Komplikasi yang digolongkan sebagai MACE adalah kematian, aritmia fatal, gagal jantung, syok kardiogenik, re-infark, dan komplikasi mekanik. Kemampuan HRV dalam memprediksi MACE dinyatakan melalui AUC (+IK95%) dan untuk parameter yang memiliki kemampuan prediksi baik akan dihitung nilai prediksi positif (PPV) dan nilai prediksi negatif (NPV) beserta IK95% parameter tersebut.Hasil: Sebanyak 75 subjek SKA menjalani pengukuran HRV < 48 jam pasca diagnosis dan sebanyak 18,7% di antaranya mengalami MACE. Parameter LF dengan AUC 0,697 (0,543-0,850) dan rasio LF/HF dengan AUC 0,851 (0,741-0,962) memiliki kemampuan diskriminasi MACE yang paling baik. Parameter LF pada titik potong 89,673 memiliki PPV dan NPV sebesar 13% dan 71%, sedangkan rasio LF/HF pada titik potong 1,718 sebesar 6% dan 50%.Kesimpulan: Variabel LF dan rasio LF/HF merupakan parameter HRV yang dinilai memiliki kemampuan diskriminasi cukup baik terhadap MACE. Kedua variabel tersebut memiliki nilai prediksi negatif sehingga dapat digunakan untuk menyingkirkan kemungkinan terjadinya MACE pada mereka dengan nilai LF > 89,673 dan rasio LF/HR > 1,718.

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ABSTRACTIntroduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.;Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718., Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.]"

"Latar belakang: Major adverse cardiac events MACE merupakan masalah yang besar yang meningkatkan morbiditas dan mortalitas pada penderita sindrom koroner akut. Belum banyak data MACE pada penderita sindrom koroner akut SKA pasca intervensi koroner perkutan IKP . Tujuan penelitian: mengetahui faktor faktor yang menjadi prediktor MACE 7 hari penderita SKA yang dilakukan IKP. Metode: Untuk mengetahui faktor-faktor yang menjadi prediktor terjadinya major adverse cardiac events pada penderita sindrom koroner akut yang dilakukan intervensi koroner perkutan dilakukan dengan metode kasus kontrol tanpa penyetaraan. Penelitian melibatkan 461 pasien SKA yang dirawat di unit perawatan intensif jantung RSCM dari tanggal 1 Januari 2015 sampai 30 November 2017. Umur, jenis kelamin wanita, diabetes melitus, hipertensi, gagal jantung, gangguan fungsi ginjal, renjatan kardiogenik, fraksi ejeksi le; 40 , stenosis di left main, aritmia, stenosis 3 arteri koronaria, stenosis di left anterior descending artery LAD dan stenosis di left main LM dilakukan penelitian prediktor terjadinya MACE. Hasil: Renjatan kardiogenik OR=10,65 p=0,001 , stenosis LAD OR=15,23 p=0,02 , fraksi ejeksi le; 40 OR=10,8 p=0,00 , faktor stenosis 3 arteri koroner atau lebih OR= 3,47 p=0,01 , gagal jantung OR=3,1 p=0,02 dan gangguan fungsi ginjal OR=4,76 p=0,00 terbukti sebagai prediktor terjadinya MACE 7 hari pada penderita SKA yang dilakukan IKP. Faktor jenis kelamin wanita, renjatan kardiogenik, stenosis LAD dan fraksi ejeksi le; 40 secara independen berhubungan dengam kejadian MACE pada pasien SKA yang dilakukan IKP, secara berturut-turut OR 95 CI 6.33 1.32-30.50 , 17.56 1.85-167.06 , 26.61 1,38-513,81 , dan 7.6 1.86-31.09. Kesimpulan: Renjatan kardiogenik, stenosis LAD, fraksi ejeksi le; 40 , faktor stenosis 3 arteri koroner atau lebih, gagal jantung dan gangguan fungsi ginjal merupakan prediktor terjadinya MACE 7 hari penderita SKA pasca IKP. Renjatan kardiogenik, stenosis LAD, wanita dan fraksi ejeksi le; 40 merupakan prediktor independen terjadinya MACE 7 hari penderita SKA pasca IKP.

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Introduction: Major Adverse Cardiac Events MACE are a big problem increasing morbidity and mortality to acute coronary syndrome patients. There is not much MACE data of acute coronary syndrome ACS patients who underwent percutaneous coronary intervention PCI . Therefore, the researcher investigated predictors factors of major adverse cardiac events.

Objective: To investigate the predictors factors of seven day MACE on ACS patients underwent PCI.

Method: To investigate the predictors factors of seven day MACE on ACS patients underwent PCI, unmatched case control was conducted. The research involved 461 ACS patients who were hospitalized in intensive coronary care unit ICCU RSCM from 1 January 2015 to 30 November 2017. Age, female gender, diabetes mellitus, hypertension, heart failure, renal dysfunction, cardiogenic shock, ejection fraction le 40, left main LM disease, arrhythmia, 3 vessel diseases, and left anterior descending artery LAD stenosis were investigate as the predictors of MACE.

Results: Cardiogenic shock OR 10.65 p 0.001, LAD stenosis OR 15.23 p 0.02 , ejection fraction le 40 OR 10.8 p 0.00 , 3 vessel diseases OR 3.47 p 0.01 , heart failure OR 3.1 p 0.02 and renal dysfunction OR 4.76 p 0.00 had been as the predictors of seven day MACE on ACS patients underwent PCI. Factors of female gender, cardiogenic shock, LAD stenosis and ejection fraction le 40 were independently predictors of seven day MACE on ACS patients underwent PCI OR 95 CI 6.33 1.32 30.50, 17.56 1.85 167.06, 26.61 1.38 513.81, and 7.6 1.86 31.09 respectively.

Conclusions: Cardiogenic shock, LAD stenosis, ejection fraction le 40, 3 vessel diseases or more, heart failure and renal dysfunction were the predictors of seven day MACE on ACS patients underwent PCI. Cardiogenic shock, LAD stenosis, female gender and ejection fraction le 40 were independent predictors of seven day MACE on ACS patients underwent PCI. The other factors were not significant."

"Latar Belakang: Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya morbiditas dan mortalitas pada pasien sindrom koroner akut (SKA). Skor prediksi MACE merupakan model yang dapat memprediksi prognosis untuk terjadinya MACE berdasarkan faktor risiko yang dimiliki oleh pasien SKA. Tujuan: Untuk membuat skor prediksi sederhana, mudah dikalkulasi dan aplikatif, yang mampu mengidentifikasi pasien SKA dengan risiko terjadinya MACE. Metode: Dilakukan penelitian kohort retrospektif pada 1002 subyek pasien SKA yang dirawat di intensive coronary care unit RSCM dalam periode waktu Januari 2010 - Desember 2013. Dilakukan evaluasi terhadap faktor risiko jenis kelamin, usia, riwayat keluarga penyakit jantung koroner, diabetes, hemoglobin, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung, deviasi segmen ST dan kelas killip. Hasil: Major Adverse Cardiac Events didapatkan pada 112 subyek (9,21%), faktor prediktor jenis kelamin wanita, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung dan kelas killip pada analisis multivariat mempergunakan regresi logistik didapatkan berhubungan bermakna dengan MACE dengan RR (95% IK) masing-masing 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), dan 6.31 (3.19-12.50) serta didapatkan akurasi prediksi yang baik dengan nilai area under curve 0,95, 95% IK, 0,93-0,97. Kesimpulan: Pada pasien SKA didapatkan probabilitas MACE sebesar 3,6% bagi yang memiliki skor total 0-6 dan 83,5% bagi yang memiliki skor > 6 berdasarkan faktor-faktor prediktor jenis kelamin wanita (skor 1), leukositosis (skor 1), peningkatan kreatinin (skor 1), hiperurisemia (skor 2), peningkatan enzim jantung (skor 1), hipotensi (skor 2), takikardi (skor 1), henti jantung (skor 5) dan kelas killip III-IV (skor 3).

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Background: Major Adverse Cardiac Events (MACE) have been known as the cause of increasing morbidity and mortality among acute coronary syndrome (ACS) patients. Prediction score have been used as prognostic to prediction MACE based on risk factor in ACS patients.

Aim: To develop a simple risk score, easily calculated and applicability that can identifies ACS patients with risk for MACE.

Methods: A cohort retrospective study involving 1002 ACS patients in intensive coronary care unit RSCM from January 2010 through December 2013. Sex, age, family history, diabetes, hemoglobin, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest, deviation ST segment and killip class as risk factor for MACE was assessed.

Results: Major Adverse Cardiac Events was found in 112 (9,21%) of ACS patients, predictor factor woman, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest and killip class in multivariate logistic regression analysis were associated with MACE in ACS patients with (RR 95% CI) 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), and 6.31 (3.19-12.50) respectively, and the best predictive accuracy for MACE was obtained by area under curve 0,95, 95% CI, 0,93-0,97.

Conclusions: In ACS patients we found probability MACE was 3,6% in patients with total score 0-6 and 83,5% for who have total score > 6 based on predictor factor woman (score 1), leukocytosis (score 1), elevated creatinine level (score 1), hyperuricemia (score 2), elevated cardiac enzyme (score 1), hypotension (score 2), tachycardia (score 1), cardiac arrest (score 5) and killip class III-IV (score 3)."

"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.

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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."

"ABSTRAKPendahuluanStudi sebelumnya menunjukkan tebal adiposa epikardial pasien sindrom koroner akut (SKA) berhubungan dengan cardiovascular adverse event dalam tiga puluh hari.TujuanMengetahui peran tebal adiposa epikardial dalam memprediksi cardiovascular adverse event pada pasien SKA di ICCU RS Cipto Mangunkusumo.MetodeDilakukan studi kohort prospektif berbasis studi prognostik pada seratus dua puluh satu pasien SKA. Tebal adiposa epikardial dinilai dengan ekokardiografi transtorakal pada fase sistolik akhir (end-systole) tampilan parasternal long axis dari tiga siklus jantung. Dilakukan follow-up dalam tiga puluh hari pada semua pasien.HasilNilai median tebal adiposa epikardial adalah 2,23 mm (kisaran 0,37 – 10,8 mm). Cardiovascular adverse event terjadi pada 23 pasien (19%) dalam 30 hari; 9 subjek mengalami syok kardiogenik, 3 subjek mengalami infark miokard berulang, 4 subjek mengalami stroke iskemik, dan 7 subjek meninggal. Titik potong terbaik tebal adiposa epikardial dalam memprediksi cardiovascular adverse event adalah 2,95 mm dengan sensitivitas 65%, spesifisitas 70%, nilai duga positif 34%, nilai duga negatif 90% dengan AUC sebesar 0,690 (IK 95% 0,564-0,816, p=0,005).SimpulanTebal adiposa epikardial 2,95 mm dapat digunakan untuk memprediksi cardiovascular adverse event dalam tiga puluh hari pada pasien SKA dengan sensitivitas 65%, spesifisitas 70% dan AUC 0,690.

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ABSTRACTBackgroundPrevious study showed that epicardial adipose thickness in acute coronary syndrome (ACS) patients was associated with cardiovascular adverse events during thirty days.ObjectiveTo determine the role of epicardial adipose thickness in predicting cardiovascular adverse events in ACS patients at ICCU of Cipto Mangunkusumo HospitalMethodA prospective cohort prognostic study was conducted on one hundred twenty-one ACS patients. Epicardial adipose thickness was measured with transthoracic echocardiography at end-systole from parasternal long-axis view of three cardiac cycles. 30 days follow-up was obtained in all patients.ResultsMedian value of epicardial adipose thickness was 2.23 mm (range 0.37-10.8 mm). Cardiovascular adverse events were developed in 23 patients (19%) during 30 days; 9 cases of cardiogenic shock, 3 of recurrent myocardial infarction, 4 of ischemic stroke, and 7 of death. Best cut-off point of epicardial adipose thickness in predicting cardiovascular adverse events was 2.95 mm with a sensitivity of 65%, specificity 70%, positive predictive value 34%, negative predictive value 90% and AUC of 0.690 (95% CI 0.564 - 0.816, p = 0.005).ConclusionEpicardial adipose thickness with cut-off point 2.95 mm could be used to predict cardiovascular adverse events during thirty days in ACS patients with a sensitivity of 65%, specificity 70% and AUC of 0.690."

"Latar Belakang. Salah satu penyebab kematian pada sindrom koroner akut adalah terjadinya komplikasi yang dikenal dengan major adverse cardiac event MACE . Terdapat beberapa prediktor terjadinya MACE pada pasien SKA, diantaranya adalah faktor psikologis yaitu depresi dan ansietas. Saat ini, depresi dan ansietas belum mendapat banyak perhatian padahal memiliki peran penting dalam pengobatan SKA dan prognosisnya. Tujuan. Mengetahui hubungan antara depresi dan ansietas dengan major adverse cardiac event dalam 7 hari pada pasien SKA. Metode. Studi dengan desain kohort prospektif untuk meneliti hubungan antara depresi dan ansietas dengan MACE dalam 7 hari pasien SKA, dengan menggunakan kuisioner HADS pada pasien SKA yang menjalani perawatan di ICCU, Rawat Inap Gedung A RSCM pada bulan Januari ndash; Mei 2018. Analisis bivariat dilakukan untuk menghitung risk ratio RR terjadinya MACE dalam 7 hari pada kelompok depresi dan ansietas dengan menggunakan SPSS. Hasil. Didapatkan jumlah subjek yang memenuhi kriteria inklusi sebanyak 114 orang. depresi didapatkan pada 7 subjek, ansietas didapatkan pada 28,95 subjek, dan MACE didapatkan pada 9,6 subjek. Pada kelompok depesi, MACE 7 hari terjadi pada 12,5 subjek. Pada kelompok Ansietas, MACE 7 hari terjadi pada 21,2 subjek. Pada analisis bivariat didapatkan ansietas meningkatkan risiko terjadinya MACE dalam 7 hari pada pasien SKA, dengan risiko relatif RR sebesar 4,2 IK 1,34 ndash; 13,7. Kesimpulan. Proporsi depresi pada pasien SKA di RSCM sebesar 7 dan proporsi ansietas pada pasien SKA di RSCM sebesar 28,95 . Ansietas pada pasien SKA merupakan prediktor independen terjadinya MACE dalam 7 hari dan meningkatkan risiko terjadinya MACE 7 hari.

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Background. One of the causes of death in acute coronary syndrome is the occurrence of a complication known as major adverse cardiac event MACE. There are several predictors of the occurrence of MACE in patients with ACS, including psychological factors such as depression and anxiety. Currently, depression and anxiety have not received much attention when it has an important role in the treatment of ACS and its prognosis.

Objective. To determine the association between depression and anxiety with major adverse cardiac event within 7 days in patients with acute coronary syndrome.

Method. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in January May 2018. Bivariate analysis was performed to calculate the risk ratio RR of MACE occurrence within 7 days in the depression and anxiety group using SPSS.

Results. Obtained number of subjects who meet the inclusion criteria of 114 people. depression was obtained in 7 of subjects, Anxiety was obtained in 28,95 of subjects, and MACE was obtained in 9.6 of subjects. In the depression group, MACE 7 days occurred in 12.5 of subjects. In the Anxiety group, MACE 7 days occurred in 21,2 of subjects. In bivariate analysis, anxiety increased the risk of MACE within 7 days in patients with ACS, with relative risk RR of 4,2 IK 1,34 ndash 13,7.

Conclusion. The proportion of depression in patients with SKA in RSCM was 7 and the proportion of anxiety in ACS patients in RSCM was 28,95. Anxiety in patients with ACS is an independent predictor of MACE within 7 days and increases the risk of a 7 day MACE. "

"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."

"Sindrom koroner akut (SKA) merupakan kondisi ketidakseimbangan antara ketersediaan dan kebutuhan oksigen pada otot jantung yang disebabkan oleh obstruksi arteri koroner. Elevasi segmen-ST infark miokard (STEMI) akut terjadi ketika pasien dengan SKA mengalami oklusi total pada pembuluh arteri koroner. Penanganan utama untuk pasien dengan STEMI adalah terapi reperfusi menggunakan angioplasti primer. Thrombolysis in myocardial infarction (TIMI) flow grade merupakan metode penilaian aliran darah, dimana TIMI 0 flow menandakan tidak adanya perfusi dan TIMI 3 flow menandakan perfusi lengkap. Penelitian ini bertujuan untuk menentukan prediktor klinis pasien yang berhubungan dengan TIMI flow akhir 3. Penelitian ini merupakan studi cross-sectional analitik yang dilaksanakan melalui pengumpulan data karakteristik klinis pasien STEMI dan TIMI flow akhir dari Jakarta Acute Coronary Syndrome (JAC) Registry. Sampel penelitian melibatkan 3706 pasien STEMI yang diobati dengan angioplasti primer antara Februari 1, 2011 dan Agustus 31, 2019. Data dianalisis menggunakan IBM SPSS versi 20. TIMI flow akhir 3 berhubungan dengan durasi antara gejala awal dan terapi reperfusi ≤6 jam (p<0.001) dan dislipidemia (p = 0.008). Sedangkan, TIMI flow akhir <3 berhubungan dengan infark miokard pada dinding anterior jantung (p = 0.03) dan kadar kreatinin dalam darah di atas 1.2 mg/dl (p = 0.03). Durasi antara gejala awal dan terapi reperfusi yang lebih dini (≤6 jam) merupakan prediktor klinis terkuat untuk TIMI flow akhir 3.

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Acute coronary syndrome (ACS) is an imbalance between oxygen supply and demand of the heart muscle due to an obstruction in the coronary artery. Acute ST-segment elevation myocardial infarction (STEMI) occurs when a patient with ACS has a complete coronary artery occlusion. The main treatment for patients with STEMI is reperfusion therapy using primary angioplasty. Thrombolysis in myocardial infarction (TIMI) flow grade is a method of measuring blood flow, where TIMI 0 flow indicates no perfusion and TIMI 3 flow indicates complete perfusion. This study is aimed to determine which clinical predictors are associated with final TIMI 3 flow. This is an analytical, cross-sectional study which was conducted through data collection of STEMI patients’ clinical characteristics and final TIMI flow from the Jakarta Acute Coronary Syndrome (JAC) Registry. The study samples include 3706 STEMI patients who were treated with primary angioplasty between February 1, 2011 and August 31, 2019. The data was analyzed using IBM SPSS version 20. Final TIMI 3 flow is associated with the duration between symptom onset and reperfusion therapy of ≤6 hours (p<0.001) and dyslipidemia (p = 0.008). Meanwhile, final TIMI <3 flow is associated with anterior wall myocardial infarction (p = 0.03) and creatinine level above 1.2 mg/dl (p = 0.03). An earlier duration between symptom onset and reperfusion therapy (≤6 hours) is the strongest clinical predictor of final TIMI 3 flow."