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"ABSTRAKLatar belakang: Sindrom Koroner Akut (SKA) merupakan manifestasi penyakit jantung koroner yang dapat menyebabkan kematian mendadak. SKA kebanyakan terjadi pada usia di atas 45 tahun, Namun beberapa tahun terakhir ini angka kejadian infark miokard usia muda meningkat.Tujuan: Mengetahui perbedaan karakteristik angiografi koroner pada pasien SKA usia ≤45 tahun dengan pasien SKA usia > 45 tahun.Metode: Beratnya stenosis pembuluh darah diukur dengan Vessel Score (jumlah pembuluh darah koroner yang sakit dengan stenosis ≥ 70%) dan Stenosis Score.Hasil: Diteliti sebanyak 322 pasien SKA yang telah menjalani angiografi koroner di ICCU RSUPN Cipto Mangunkusumo Jakarta mulai Januari 2008 sampai Desember 2012. Pasien dibagi kedalam dua kelompok. Kelompok satu adalah pasien usia ≤45 tahun dan kelompok kedua pasien usia>45 tahun. Ditemukan 322 pasien SKA (72 kasus ≤45 tahun dan 250 kasus >45tahun). Distribusi jumlah pembuluh darah yang sakit (vessel score) 1 VD (single vessel diseases) terbanyak pada usia ≤ 45 tahun (43.1 % vs 26.0 % ), sedangkan 3 VD (triple vessel diseases) terbanyak pada usia > 45 tahun (31.6 % vs 18,1 %). Hasil skor stenosis menunjukkan lebih rendah pada usia ≤ 45 tahun dibandingkan usia  45 tahun (median skor stenosis 4 vs 8) dengan perbedaan yang bermakna (p<0,001). Pembuluh darah yang mengalami aterosklerosis yang terbanyak adalah Left Anterior Descending baik kelompok usia ≤ 45 tahun dan usia  45 tahun (65.3% and 74.0%). Pembuluh darah Left Circumflex dan Right Coronary Artery lebih sedikit pada usia ≤ 45 tahun dan bermakna secara statistik (26,4% dan 31,9% vs 46,4% dan 57,2%, p=0,002 dan 0,001).Simpulan: Jumlah pembuluh darah koroner yang sakit (vessel score) dan skor stenosis lebih kecil pada usia ≤ 45 tahun dibanding usia > 45 tahun

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ABSTRACTBackground: Acute Coronary Syndrome (ACS) is the manifestation of coronary heart disease which can cause sudden death. ACS mostly occurs at the age > 45 years, but recently the incidence of myocardial infarction increases in yong ages.Objective: To determine compared between coronary angiography of acute coronary syndrome patients age ≤ 45 years with acute coronary syndrome patients age > 45 years.Methods: The severety of coronary stenosis was determined by Vessel score and Coronary score. Significant vessel score was defined as stenosis of angiography of more or equal to 70% lumen stenosis by eyeball examinationResults :A total of 322 ACS patients who undergone coronary angiography in ICCU Cipto Mangunkusumo from January 2008 to December 2012. Patients were divided into two groups. One patient group is less or equal to the age of 45 years (72 cases) and the second group of patients over the age of 45 years (250 cases).Distribution of number of blood vessels disease 1 VD (single vessel diseases) highest in the age group ≤ 45 years (43.1 % vs 26.0 % ), while 3 VD (triple vessel diseases) highest in the age group > 45 years (31.6 % vs 18,1 %). stenosis score was lower at age ≤ 45 years to compare age > 45 years (median stenosis score 4 vs 8) with statistical significant difference (p < 0.001 ). The Left Anterior Descending Artery significant lesion was found high at the both age groups (65.3% and 74.0%). But the significant stenosis lesion was less found in Left Circumflex and Right Coronary Artery at the age ≤ 45 years (26,4% and 31,9% vs 46,4% and 57,2%, p=0,002 and 0,001).Conclusion :The number of coronary arteries diseases (Vessel score) and Stenosis score is lower at the age ≤ 45 years compared to patients age > 45 years."

"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: 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."

"Pendahuluan: Jumlah pasien Sindrom Koroner Akut SKA semakin meningkat dari tahun ketahun. Ticagrelor merupakan penghambat P2Y12 dengan onset cepat dan efekhambatan platelet lebih besar dibandingkan klopidogrel, namun memiliki masalahmeningkatnya efek samping perdarahan mayor, efek samping lain, dan biaya yanglebih mahal. Penelitian ini bertujuan melakukan evaluasi efektifitas, keamanan,dan cost effectiveness analysis ticagrelor dibandingkan klopidogrel add on aspirinpada pasien SKA sejak tahun 2014-2016 di RSUPN Cipto Mangunkusumo.Metode:Penelitian ini menggunakan design kohort retrospektif. Rekam medis dari pasienSKA yang pertama kali didiagnosa dan diterapi dengan klopidogrel dan pasienSKA yang pertama kali didiagnosa dan diterapi dengan ticagrelor dimasukkankedalam kriteria inklusi. Outcome efektivitas adalah insiden major adversecardiovascular events MACE yang dapat dicegah dalam 3, 6, 9, dan 12 bulan.Outcome safety adalah insiden efek samping yang timbul dalam 3 bulan.Outcomebiaya dinilai dengan cost effectiveness analysis CEA . Data untuk CEA disajikandalam bentuk incremental cost effectiveness ratio ICER . Untuk menilaiketidakpastian data uncertainty digunakan analisa sensitivitas satu arah.Hasil:Rekam medis dari 123 pasien klopidogrel-aspirin dan 57 pasien ticagrelor-aspirinberhasil dievaluasi. Trend pemakaian ticagrelor semakin meningkat sejak tahun2014 sampai dengan 2016, sedangkan klopidogrel semakin menurun. Outcomeefektivitas adalah MACE yang dapat dicegah dalam 3 bulan. Dalam 3 bulanMACE terjadi pada 15.8 pasien di kelompok ticagrelor dan 31.7 pasien dikelompok klopidogrel RR; 0,498, 95 CI; 0,259 ndash;0,957, P = 0,039 . Tidak adaperbedaan signifikan pada bulan ke 6,9, dan 12. Ticagrelor memiliki efek sampingperdarahan mayor melena lebih tinggi dibanding klopidogrel 5,3 vs 1,62 , P= 0,681 , terutama pada pasien geriatri. ICER = Rp 279.438,87., denganpengertian diperlukan tambahan biaya Rp 279.438,87., untuk setiap insidenMACE yang dapat dihindari dalam 3 bulan jika digunakan ticagrelor sebagaiDAPT. ICER tersebut dianggap cost effective karena berada dibawah 1 GDP Gross Domestic Product Indonesia tahun 2016, yaitu 3603 Rp 49.000.800.Kesimpulan: Ticagrelor-aspirin lebih efektif dan lebih cost-effective dalam mencegah MACEdalam 3 bulan dibandingkan klopidogrel-aspirin pada pasien SKA. Masihdiperlukan penelitian prospektif lanjutan dengan jumlah besar terutama padapasien geriatri dengan SKA.

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Introduction The enormous number of acute coronary syndrome ACS cases make it importantto evaluate the economic burden of this illness. Ticagrelor is a P2Y12 inhibitorwith pronounced platelet inhibition effect and more rapid onset compared toclopidogrel, with disadvantages of higher price and major bleeding adverseeffects. This study aimed to evaluate effectiveness, safety, and cost effectivenessanalysis of dual antiplatelet aspirin ticagrelor compared with aspirin clopidogrelat ACS patients in Cipto Mangunkusumo Hospital during 2014 2016Methods This is a retrospective cohort study from data records of ACS patient treated inCipto Mangunkusumo Hospital between 2014 2016 period. ACS patientsdiagnosed and treated for the first time with aspirin clopidogrel and patientsdiagnosed and treated for the first time with aspirin ticagrelor were included.Effectiveness outcome were the occurence of major adverse cardiovascular events MACE successfully avoided within 3, 6, 9, and 12 months of antiplatelettreatment. Safety outcome were the insidence of adverse drug reactions within 3months. Cost outcome were determined with cost effectiveness analysis CEA .Data for CEA calculation were presented as Incremental Cost Effectiveness Ratio ICER . One way sensitivity analysis were performed to evaluate data uncertainty.Results A total of 123 data records of ACS patients treated with aspirin clopidogrel and57 with aspirin ticagrelor were evaluated. Trend for antiplatelet prescriptionshowed that ticagrelor prescription increased since 2014 until 2016, whileclopidogrel decreased. Within the first three months, the MACE rate was 15.8 inticagrelor group and 31.7 in clopidogrel group RR 0,498, 95 CI 0,259 ndash 0,957, P 0,039 . There were no significant differences of MACE betweengroups after 6, 9, and 12 months treatment. Ticagrelor had unsignificant majorbleeding melena higher than clopidogrel 5,3 vs 1,62 , P 0,681, especiallyin geriatric patients. ICER value was IDR 279.438,87, indicating additional costneeded for every MACE incidence successfully avoided within 3 month if aspirinticagrelorwas used. ICER under 1 Indonesian GDP Gross Domestic Product in2016 3603, equal to IDR 49.000.800 is considered cost effective.Conclusions Ticagrelor aspirin is a clinically superior and cost effective option for MACEprevention among ACS patients especially during the first three monthsantiplatelet treatment. Further prospective rearch with higher number especially ingeriatric patients with ACS is still needed."

"Penyakit jantung koroner merupakan penyakit degeneratif yang masih menjadi permasalahan kesehatan di dunia. Salah satu faktor penyakit jantung koroner ini adalah obesitas sentral. Persentase status obesitas sentral ini mengalami kenaikan dari tahun 2007 sampai 2013. Penelitian ini dilakukan untuk melihat hubungan obesitas sentral terhadap penyakit jantung koroner.Desain studi yang digunakan adalah cross sectional dan menggunakan data Riskesdas 2013. Sampel penelitian ini adalah semua penduduk yang berusia 45 tahun ke atas yang memenuhi kriteria inklusi dan ekslusi.Hasil penelitian ini menunjukkan bahwa prevalensi penyakit jantung koroner adalah 1,2 dan terdapat hubungan antara status obesitas sentral terhadap penyakit jantung koroner pada usia 45 tahun ke atas di Indonesia tahun 2013 setelah dikontrol oleh variabel konfounding. Faktor yang menjadi konfounding adalah penyakit diabetes, hipertensi, dan perilaku merokok. Selain itu, terdapat interaksi oleh variabel konfounding terhadap obesitas sentral yaitu diabetes dan merokok. Oleh karena itu,diperlukan promosi kesehatan mulai dari promosi kesehatan penyakit jantung koroner baik pencegahan primer maupun pencegahan sekunder.

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Coronary heart disease is a degenerative disease that remains a health problem in the world. One of the factors of coronary heart disease are central obesity. The percentage of central obesity status is increased from 2007 to 2013. This study was conducted to examine the relationship of central obesity to coronary heart disease.The study design used is cross sectional and use data Riskesdas 2013. Samples were all residents aged 45 years and over who meet the inclusion and exclusion criteria.The results of this study indicate that the prevalence of coronary heart disease was 1.2 and there is corelation between central obesity status of coronary heart disease at the age of 45 years and over in Indonesia in 2013 after being controlled by confounding variables. Confounding factors that are diabetes, hypertension, and smoking behavior. In addition, there is an interaction by confounding variables to central obesity, namely diabetes and smoking. Therefore, required health promotion ranging from coronary heart disease health promotion both primary prevention and secondary prevention."

"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."

"Kecemasan pada pasien coronary arteri disease (CAD) dapat menyebabkan perburukan terhadap perkembangan penyakit. Pengkajian untuk menilai kecemasan dari awal diperlukan untuk menghindari bahaya yang ditimbulkan dari kecemasan pasien. Kuesioner cardiac anxiety questionnaire (CAQ) adalah kuesioner untuk mengkaji kecemasan yang spesifik pada pasien dengan gangguan kardiovaskuler. Tujuan penerapan kuesioner CAQ untuk menilai validitas dan realibilitas sebagai alat ukur dalam menilai tingkat kecemasan pasien dengan gangguan system kardiovaskuler. Strategi penulusuran dengan menggunakan database dengan pendekatan PICO (Population, Intervention, Comparation dan Outcome), ditemukan ada 35 jurnal dan ditentukan 5 jurnal dengan karakteristik sample yang hampir sama. Penerapan pengkajian kuesioner CAQ terhadap 30 pasien di RS Pusat Jantung Harapan Kita Jakarta, hasil didapatkan rerata skor nilai total kuesioner CAQ adalah 30.30 dengan standar deviasi sebesar 13.2 dengan estimasi interval 95% skor nilai total CAQ berada pada rentang 25.37 – 35.2. Uji validitas didapatkan 14 dari 18 pertanyaan valid dan uji reabilitas mempunyai nilai 0.861 (> r table = 0,361) sehingga CAQ dapat ditetapkan di RS Pusat Jantung Nasional Jakarta

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Anxiety is patients with coronary artery disease (CAD) can cause worsening of disease progression. Assessment to assess anxiety from the beginning is necessary to avpid the dangers posed by anxiety. The Cardiac anxiety quesionnarie (CAQ) is heart focused anxiety quessionnarie the purpose of applying the CAQ questionnaire ti assess the validity and realibility as a measuring tool in assessing anxiety levels of patients with cardiovascular disorder. The search strategy using a databased with the PICO (Population, Intervention, Comparation dan Outcome) approach, found there were 35 journals and determined 5 journals with nearly identical sample characteristics. Applying the CAQ questionnaire assessmet to 30 patients at National Cardiovasculer Center Harapan Kita. The result shows that the average score of CAQ questionnaire total is 30.30 with standard deviation of 13.2 with 95% interval estimateof total CAQ value score in range 25.37 – 35.2. Validity test obtained 14 out of 18 valid questions and reliability test has velue of 0.861 (> r table = 0.361) so that CAQ questionnaire can bi determined at National Cardiovasculer center Harapan kita."

"ABSTRAK Latar Belakang: Aritmia selama perawatan merupakan komplikasi yang sering terjadi pada pasien sindrom koroner akut (SKA) sehingga dibutuhkan identifikasirisiko secara dini. Tujuan: Mengetahui insidens pasien SKA yang mengalami aritmia selamaperawatan dan mengetahui pengaruh hiperglikemia admisi terhadap kejadianaritmia selama perawatan pasien SKA. Metode: Studi kohort retrospektif ini menggunakan rekam medik pasien SKA yangdirawat di ICCU RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari-31Desember 2014. Hiperglikemia admisi didefinisikan sebagai kadar gula darahadmisi >140 mg/dL. Kejadian aritmia selama perawatan meliputi aritmia atrium,takikardia supraventrikular, blok AV derajat tinggi, dan aritmia ventrikel, yangdiidentifikasi dalam tujuh hari pertama perawatan. Hasil: Terdapat 232 subjek pada penelitian ini. Prevalensi hiperglikemia admisiadalah 50,43%. Insidens pasien SKA yang mengalami aritmia selama perawatanadalah 21,55% (IK 95% 16,26-26,84). Analisis bivariat menunjukkanhiperglikemia admisi terkait dengan peningkatan risiko aritmia selama perawatan(RR 1,747; IK 95% 1,042-2,930). Tidak terdapat hubungan yang bermakna antarajenis SKA, diabetes melitus (DM), obesitas, dan hipertensi dengan kejadian aritmiaselama perawatan. Analisis multivariat menunjukkan OR hiperglikemia admisisetelah penyesuaian adalah 2,852 (IK 95% 1,351-6,024), dengan variabel perancuDM. Simpulan: Insidens pasien SKA yang mengalami aritmia selama perawatan adalah21,55%. Hiperglikemia admisi dapat meningkatkan risiko kejadian aritmia selama perawatan pasien SKA.ABSTRACT Background: The in-hospital arrhythmias complicating acute coronary syndrome

(ACS) is a common complication, and its ealy risk identification is urgently needed.

Aim: to determine the incidence of in-hospital arrhythmia complicating ACS and

to determine the influence of HA on in-hospital arrhythmia complicating ACS.

Methods: a retrospective cohort study was conducted using secondary data from

medical records of patients with ACS who were admitted to ICCU RSCM between

January 1st-Desember 31st, 2014. Hyperglycemia at admission was defined when

the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias

were observed during the first seven days of hospitalization.

Result: there were 232 subjects. The prevalence of HA WAS 50.43%. The

incidence of in-hospital arrhythmias was 21.55% (95% CI 16.26-26.84). In

bivariate analysis, there was significant association between HA and in-hospital

arrhythmia (RR 1.747; 95% CI 1.042-2.930). There were no significant relationship

among the type of ACS, diabetes mellitus (DM), obesity, and hypertension, with

the influence of HA on in-hospital arrhythmia. In multivariate analysis, the adjusted

OR of HA was 2.852 (95% CI 1.351-6.024), and DM was the confounding variable.

Conclusion: In-hospital arrhythmias is a common complication in patients with

ACS. Hyperglycemia at admission may increase the risk of in-hospital arrhythmia complicating ACS. ;Background: The in-hospital arrhythmias complicating acute coronary syndrome

(ACS) is a common complication, and its ealy risk identification is urgently needed.

Aim: to determine the incidence of in-hospital arrhythmia complicating ACS and

to determine the influence of HA on in-hospital arrhythmia complicating ACS.

Methods: a retrospective cohort study was conducted using secondary data from

medical records of patients with ACS who were admitted to ICCU RSCM between

January 1st-Desember 31st, 2014. Hyperglycemia at admission was defined when

the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias

were observed during the first seven days of hospitalization.

Result: there were 232 subjects. The prevalence of HA WAS 50.43%. The

incidence of in-hospital arrhythmias was 21.55% (95% CI 16.26-26.84). In

bivariate analysis, there was significant association between HA and in-hospital

arrhythmia (RR 1.747; 95% CI 1.042-2.930). There were no significant relationship

among the type of ACS, diabetes mellitus (DM), obesity, and hypertension, with

the influence of HA on in-hospital arrhythmia. In multivariate analysis, the adjusted

OR of HA was 2.852 (95% CI 1.351-6.024), and DM was the confounding variable.

Conclusion: In-hospital arrhythmias is a common complication in patients with

ACS. Hyperglycemia at admission may increase the risk of in-hospital arrhythmia complicating ACS. "