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"ABSTRAKLatar belakangPenyakit jantung Koroner (PJK) merupakan penyebab kematian yang tertinggi di dunia dan cenderung meningkat dari tahun ke tahun. Skor TIMI STEMI sudah banyak digunakan dan divalidasi sebagai prediktor kematian pasien STEMI namun belum mencakup komponen fraksi ejeksi ventrikel kiri (FEVK) dan laju filtrasi glomerulus (LFG), dan kurang optimal dalam penggunaanya.TujuanMemodifikasi skor TIMI STEMI dengan memasukkan variabel FEVK dan LFG sebagai prediktor mortalitas pada pasien STEMI dalam 30 hari di RSCM. Metode Studi kohort retrospektif terhadap 487 pasien STEMI yang di rawat di RSUPN Cipto Mangunkusumo pada periode 2004-2013. Data variabel prediktor diperoleh dari penelusuran rekam medis. Data yang didapatkan dianalisis secara bivariat dan multivariat, setelah itu dibuat formulasi baru prediktor mortalitas pasien STEMI dalam 30 hari dan akan diujikan pada seluruh data dan dinilai risiko mortalitasnya serta dibandingkan dengan skor TIMI dengan AUC (area under curve).HasilDari analisis secara bivariat dan multivariat didapat hanya dua variabel yang dapat digunakan dalam formula baru yaitu kelas killips II-IV dan LFG dengan kisaran total skor 0-4.6 Stratifikasi risiko mortalitas dalam 30 hari pada pasien STEMI adalah tinggi (total skor >3,5; 46,5%), sedang (total skor 2,5-3,5;23,2%), dan rendah (total skor <2,5;5,95%). Diskriminasi modifikasi skor TIMI STEMI dengan AUC 0.816; IK 95%; 0.756-0.875.KesimpulanModifikasi skor TIMI STEMI terdiri dari dua variabel yaitu kelas Killip dan LFG. Modifikasi ini memiliki kalibrasi dan diskriminasi yang baik sebagai prediktor mortalitas 30 hari pada pasien STEMI.

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ABSTRACTBackgroundCoronary Heart Disease (CHD) is the leading cause of death in the world and the rate increases every year. TIMI STEMI score has been used and validated as mortality predictor for STEMI patient but unfortunately, it does not involve left ventricle ejection fraction (LVEF) and Glomerulus filtration rate (GFR), thus it is less optimal in clinical setting.ObjectiveTo modify TIMI STEMI score include LVEF and GFR as variables for 30 day mortality predictor STEMI patients in RSUPN Cipto Mangunkusumo Hospital. Methods Retrospective cohort study was done toward 487 STEMI inpatients in RSUPN Cipto Mangunkusumo Hospital in 2004-2013. Predictor variable data was obtained from medical records. The data was analyzed with bivariate and multivariate method using Cox’s Proportional Hazard Regression Model. Subsequently, formulate new predictors for STEMI patient mortality rate in 30 days. In these newly formulated predictors shall be stratified to all data and mortality risk shall be assessed and compared with current TIMI STEMI Score using area under curve (AUC).ResultsFrom bivariate and multivariate analysis, only two variables were found to have significant values for new formulation; Killip class II-IV and GFR which contribute 0.4.6 of total score value. 30 day mortality risk stratification for STEMI patient is high if total score > 3.5;46.5%, moderate if total score 2.5-3.5;23.2% and low if total score < 2.5;5.95%. Modified TIMI STEMI Score has a good discrimination rate with AUC value of 0.816 (0.756-0.875) and confidence interval (CI) 95%.ConclusionModified TIMI STEMI Score has two variables such as Killip Class and GFR. It has good calibration and discrimination for 30 day mortality predictor in STEMI patients."

"[ABSTRAKLatar belakang dan tujuan: Menentukan korelasi nilai Ejection Fraction (EF) ventrikel kiri pada echo 2D dan DSCT jantung pada pasien Penyakit Jantung Koroner (PJK) stabil di RSUPN Cipto Mangunkusumo, sehingga nilai EF ventrikel kiri DSCT jantung dapat dijadikan acuan untuk evaluasi, penatalaksanaan dan prognosis pada PJK stabil yang mempunyai indikasi dilakukan CT jantung.Metode: Analisa retrospektif dari 30 pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak waktu ≤ 3 bulan, meliputi penilaian EF ventrikel kiri. Berdasarkan nomor rekam medis yang ada, dilakukan pengambilan data EF ventrikel kiri echo 2D serta data tambahan lainnya. Nilai EF ventrikel kiri secara DSCT di evaluasi kembali pada cardiac workstation (Siemens, Leonardo), kemudian ditentukan bagaimana korelasinya dengan nilai EF ventrikel kiri secara echo 2D. Analisis statistik penelitian ini menggunakan uji SpearmanHasil: Terdapat perbedaan nilai EF ventrikel kiri sebanyak 4% antara echo 2D dengan DSCT jantung. Perbedaan sebanyak 4% ini tidak bermakna signifikan secara klinis namun bermakna secara statistik. Nilai R Spearman yang didapat adalah 0,17 sementara nilai p 0,364 (p > 0,005), artinya tidak terdapat korelasi antara nilai EF ventrikel kiri secara echo 2D dengan DSCT jantung pada pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak ≤ 3 bulan di RSUPN Cipto Mangunkusumo.Kesimpulan: Walaupun pada penelitian ini secara statistik tidak berkorelasi, namun pada keadaan hasil echo yang borderlineatau pada pasien PJK stabil yang mempunyai indikasi dilakukan CT jantung, nilai EF ventrikel kiri pada CT dapat menjadi acuan untuk penatalaksanaan selanjutnya.

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ABSTRACTBackground and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.;Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management., Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.]"

"Sindrom koroner akut berkontribusi pada tingginya angka morbiditas dan mortalitas terkait kasus penyakit kardiovaskular, dengan salah satu penyebab mortalitas tertinggi yaitu STEMI(ST Elevation Myocardial Infarction). Keterlambatan penanganan pasien STEMI menjadi penyebab tingginya mortalitas dan kejadian MACE (Major Adverse Cardiac Event), serta berpengaruh terhadap kualitas pelayanan kesehatan.Program CODE STEMI diciptakan dengan harapan dapat menyelesaikan keterlambatan ini serta meningkatkan kualitas pelayanan terhadap pasien. Penelitian ini bertujuan untuk mengetahui pengaruh pelaksanaan program CODE STEMI terhadap kualitas pelayanan pasien dengan STEMI di RSUPN Dr. Cipto Mangunkusumo.Metode yang digunakan adalah metode operasional secara kuantitatif dan kualitatif dengan desain kohort retrospektif. Data kuantitatif didapatkan dari telaah dokumen dengan jumlah sampel 207 pasien (135 kelompok CODE STEMI, 72 kelompok Non CODE STEMI), sedangkan data kualitatif didapatkan dari wawancara mendalam dengan sepuluh informan penelitian. Analisis data dilakukan secara kuantitatif dengan uji Mann whitney (Door to balloon time, total biaya RS, lama rawat) dan chi square (kejadian Mortalitas dan MACE). Hasil penelitian menunjukan terdapat perbaikan yang bermakna untuk door to balloon time, total biaya dan lama rawat pasien STEMI pada pasien yang ditangani dengan CODE STEMI. Selain itu terdapat kecenderungan penurunan angka kejadian MACE dan mortalitas setelah diterapkan program CODE STEMI. Baik pihak rumah sakit maupun pasien mengaku puas dengan program CODE STEMI tersebut. Program ini terbukti memiliki efikasi, efektivitas, optimalitas, akseptibilitas, legitimasi, dan ekuitas yang baik serta memenuhi prinsip-prinsip manajemen yang baik untuk sebuah program pelayanan. Kesimpulan penelitian ini adalah program CODE STEMI berpengaruh baik terhadap kualitas pelayanan pasien dengan STEMI di RSUPN Dr. Cipto Mangunkusumo.

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Acute coronary syndrome contributes to high rates of morbidity and mortality associated with cardiovascular disease, with one of the highest causes of mortality is STEMI (ST Elevation Myocardial Infarction). Delay in the management of STEMI patients is a cause of high mortality and the incidence of MACE (Major Adverse Cardiac Event), as well as affecting healthcare quality. This delay may be solved by the CODE STEMI program. This study aims to determine the effect of the implementation of the CODE STEMI program on the quality of healthcare services with patients with STEMI at Dr. Cipto Mangunkusumo Hospital. The method used was an observational method using quantitative and qualitative approach with a cross sectional design. Quantitative data were obtained from a medical records with a sample of 207 patients (135 CODE STEMI groups, 72 Non-CODE STEMI groups), while qualitative data were obtained from in-depth interviews with ten research informants. Data analysis was performed quantitatively by Mann Whitney test (Door to balloon time, total hospital costs, length of stay) and chi square test (Mortality and MACE events). The results of the study shows a significant reduction in terms of door to balloon time, total cost, and length of stay of STEMI patients treated with CODE STEMI. In addition, there is a decreasing tendency of the incidence of MACE and mortality after the application of the CODE STEMI program. Both the hospital and the patient said they were satisfied with the CODE STEMI program. This program is proven to have a good efficacy, effectivity, optimality, acceptability, legitimation, and equity. It also met the required principles of good management for healthcare program. The conclusion of this study is that the CODE STEMI program has a good impact on the healthcare quality of patients with STEMI in Dr. Cipto Mangunkusumo National Central General Hospital. "

"Latar Belakang: Hingga saat ini belum ada publikasi yang melakukan pembahasan mengenai sistem stratifikasi risiko pasien STEMI pada populasi dewasa muda. Selain itu rokok dan riwayat PJK dini dalam keluarga yang merupakan faktor risiko utama kejadian STEMI pada dewasa muda juga belum terlihat perannya dalam sistem stratifikasi risiko manapun. Skor TIMI yang paling banyak digunakan dalam menilai prognosis pasien STEMI juga masih dipertanyakan keakuratannya pada kelompok dewasa muda.

Tujuan: Studi ini bertujuan mengetahui proporsi mortalitas pasien STEMI dewasa muda yang di RS Cipto Mangunkusumo, melakukan validasi skor TIMI pada pasien dewasa muda, dan mengembangkan sistem stratifikasi risiko untuk pasien STEMI dewasa muda.

Metode: Penelitian ini adalah studi prognosis dengan desain kohort retrospektif menggunakan data rekam medis RSCM pada pasien berusia ≤50 tahun yang dirawat dengan STEMI dari tahun 2018 hingga tahun 2022. Dilakukan analisis univariat untuk mendapatkan data karakteristik subjek dan proporsi mortalitas 30 hari pasien STEMI dewasa muda. Dilakukan analisis bivariat untuk melihat hubungan merokok dan Riwayat PJK dini dalam keluarga dengan mortalitas 30 hari. Dilakukan uji validasi skor TIMI pada subjek penelitian dewasa muda. Dilakukan analisis multivariat untuk mendapatkan model prediksi baru dan dilakukan uji performa diskriminasi dan kalibrasi model modifikasi atau kombinasi baru.

Hasil: Didapatkan 164 subjek penelitian. Pasien yang memiliki faktor risiko merokok adalah sebanyak 107 orang (65,2%). Sementara yang memiliki riwayat PJK dini dalam keluarga adalah sebanyak 39 orang (23,9%). Pasien yang memiliki komorbid hipertensi sebanyak 80 orang (48,8%) dan yang menderita diabetes sebanyak 71 orang (43,3%). Proporsi mortalitas 30 hari pasien dewasa muda sebanyak 7,9% (13 orang). Tidak terdapat korelasi dengan mortalitas 30 hari pasien STEMI dewasa muda untuk riwayat merokok (HR 0,0441 (IK 95% 0,148-1,312) dan nilai p 0,141) dan riwayat PJK dini dalam keluarga (HR 0,567 (IK 95% 0,126-2,559) dan nilai p 0,461). Skor TIMI memperlihatkan kemampuan prediksi mortalitas 30 hari pasien STEMI dewasa muda yang baik, dimana didapatkan nilai AUC 0,836 (IK 95% 0,717-0,956) dengan nilai p <0,0001. Kombinasi skor TIMI dengan variabel riwayat merokok memperlihatkan performa diskriminasi yang baik dalam prediksi mortalitas 30 hari pasien STEMI dewasa muda dengan nilai AUC 0,875 (p<0,0001). Namun ketika dilakukan perbandingan antara nilai AUC skor TIMI dengan skor TIMI dengan tambahan faktor riwayat merokok tidak didapatkan peningkatan akurasi yang bermakna (nilai p 0,2146).

Simpulan: Proporsi mortalitas 30 hari pasien STEMI dewasa muda adalah sebanyak 7,9%. Skor TIMI memiliki performa diskriminasi dan kalibrasi yang baik dalam memprediksi mortalitas 30 hari pasien STEMI dewasa muda. Skor TIMI dengan penambahan faktor riwayat merokok memiliki performa diskriminasi dan kalibrasi yang lebih baik dalam memprediksi mortalitas 30 hari pasien STEMI dewasa muda dibandingkan skor TIMI murni, namun tidak memiliki signifikansi peningkatan akurasi.

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Background: Until now, there have been no publications discussing the risk stratification system for STEMI patients in the young adult population. Additionally, the role of smoking and a family history of early coronary artery disease (CAD) as major risk factors for STEMI in young adults has not been addressed in any risk stratification system. The accuracy of the widely used TIMI score in assessing the prognosis of STEMI patients in the young adult group is also questionable.

Objective: This study aims to determine the proportion of mortality among young adult STEMI patients at Cipto Mangunkusumo Hospital, validate the TIMI score in young adult patients, and develop a risk stratification system for young adult STEMI patients.

Methods: This research is a retrospective cohort prognosis study using medical record data from Cipto Mangunkusumo Hospital on patients aged ≤50 years who were hospitalized with STEMI from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the proportion of 30-day mortality among young adult STEMI patients. Bivariate analysis was performed to examine the relationship between smoking, a family history of early CAD, and 30-day mortality. The validation of the TIMI score was conducted in the young adult study subjects. Multivariate analysis was conducted to obtain a new prediction model, and performance tests for discrimination and calibration of the modified or combined model were performed.

Results: A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young adult patients was 7.9% (13 individuals). There was no correlation between 30-day mortality in young adult STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312) and p-value 0.141) or a family history of early CAD (HR 0.567 (95% CI 0.126-2.559) and p-value 0.461). The TIMI score showed good predictive ability for 30-day mortality in young adult STEMI patients, with an AUC value of 0.836 (95% CI 0.717-0.956) and p-value <0.0001. The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young adult STEMI patients, with an AUC value of 0.875 (p<0.0001). However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value 0.2146).

Conclusion: The proportion of 30-day mortality among young adult STEMI patients is 7.9%. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young adult STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young adult STEMI patients compared to the pure TIMI score but does not significantly enhance accuracy."

"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: Keputusan pasien untuk menjalani bedah pintas koroner dipengaruhi risiko mortalitas. Skor Age, Creatinine and Ejection Fraction ACEF merupakan prediktor mortalitas 30 hari pascabedah pintas koroner yang sederhana dan telah ditunjukkan memiliki performa yang setara dengan skor lain yang lebih kompleks. Tujuan: Menilai performa kalibrasi dan diskriminasi skor ACEF dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSUPN Dr. Cipto Mangunkusumo RSCM. Metode: Penelitian ini merupakan studi kohort retrospektif terhadap pasien penyakit jantung koroner dewasa yang menjalani bedah pintas koroner di unit Pelayanan Jantung Terpadu PJT RSCM tahun 2013 ndash; 2015. Usia, kreatinin, dan fraksi ejeksi dinilai sebelum pasien menjalani bedah. Pasien diikuti hingga 30 hari pascabedah untuk dilihat outcome-nya meninggal atau tidak. Performa kalibrasi skor ACEF dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor ACEF dinilai dengan area under the curve AUC. Hasil: Sebanyak 308 subjek diikutsertakan dalam analisis. Performa kalibrasi skor ACEF dengan uji Hosmer-Lemeshow menunjukkan p=0,991 dan plot kalibrasi menunjukkan koefisien korelasi r=0,95. Performa diskriminasi skor ACEF ditunjukkan dengan nilai AUC sebesar 0,728 IK95 0,644; 0,811. Simpulan: Skor ACEF memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSCM.

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Background: The preference of patients to undergo coronary artery bypass grafting CABG surgery is influenced by the risk of mortality. Age, Creatinine and Ejection Fraction ACEF score is a simple predictor of 30 day mortality following CABG surgery and had been shown to be equivalent to more complex models.

Aim: To assess calibration and discrimination performance of ACEF score in predicting 30 day mortality following CABG surgery in Cipto Mangunkusumo Hospital.

Methods: This was a retrospective cohort study of adult coronary artery disease patients undergoing CABG surgery in Integrated Cardiovascular Center, Cipto Mangunkusumo Hospital between 2013 ndash 2015. Age, creatinine, and ejection fraction value were obtained before surgery. The subjects were followed up for up to 30 days postoperatively to assess the outcome dead or alive. Calibration performance were assessed by Hosmer Lemeshow test and calibration plot. Discrimination performance were assessed by the area under the curve AUC.

Results: A total of 308 subjects were included in analysis. Hosmer Lemeshow test of ACEF score showed p 0.991 and calibration plot showed r 0.95. Discrimination of ACEF score was shown by the AUC value of 0.728 95 CI 0.644 0.811.

Conclusion: ACEF score have a good calibration and discrimination performance in predicting 30 day mortality following CABG surgery in Cipto Mangunkusumo Hospital."

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

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

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

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

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

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

"Latar Belakang. COVID-19 sempat menjadi pandemi global yang fatal. Penggunaan dari remdesivir sebagai terapi emergensi pada pertengahan tahun 2020 menyebabkan munculnya berbagai laporan yang mengaitkan penggunaannya terhadap gagal ginjal akut. Molekul sulfobutylehter-beta-cyclodextrin (SBECD) yang dapat menumpuk pada ginjal dicurigai sebagai penyebabnya. Remdesivir lebih diutamakan pada kasus berat dan proporsi dari gagal ginjal akut lebih tinggi dilaporkan pada pasien perawatan ICU, sehingga penelitian ini ditujukan untuk mengetahui bagaimana fungsi ginjal dapat terganggu akibat penggunaannya. Metode. Penelitian dilakukan secara observasional, pengumpulan data berdasarkan rekam medis RS Swasta di Tangerang periode Januari 2021-Juli 2022. Analisis menggunakan uji dan dibentuk model prediktif dengan regresi linear. Hasil. Dari 46 subyek yang mendapat terapi remdesivir didapatkan mayoritas adalah laki-laki dengan median usia 57 tahun. Model prediktif dengan variabel usia, jenis kelamin, hipertensi, DM, CRP, dan D-dimer menghasilkan nilai P 0,341; R2 0,153. Analisis stratifikasi dengan hipertensi, DM, CRP dan D-dimer menunjukkan adanya kemaknaan secara statistik (nilai P < 0,05). Kesimpulan. Terapi dengan remdesivir pada pasien COVID-19 yang dirawat di ICU dapat mengalami penurunan fungsi ginjal yang bermakna. Faktor risiko hipertensi, DM, nilai CRP dan D-dimer yang tinggi dapat memperburuk penurunan fungsi ginjal, sehingga perlu diperhatikan penggunaannya pada praktik klinis sehari-hari.

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Background. COVID-19 was a terrifying global pandemic. The use of remdesivir as emergency treatment of COVID-19 was approved during the mid of 2020 and since then there were reports indicating acute kidney injury. This was hypothesized to be caused by SBECD which can cause deposits in the kidney. Remdesivir has been widely used in severe cases and acute kidney injury was found to be higher in ICU patients. Therefore, this study aims to show how these factors can cause kidney injury.

Methods. This observational study was conducted using hospital medical records from private hospitals in Tangerang during January 2021 to July 2022. These data were analysed using Wilcoxon and predictive model generated with linear regression.

Results. Total of 46 subjects in which most participants were male with the age median of 57 years old. Predictive model with age, gender, hypertension, DM, CRP, and D-dimer showed a P-value 0,341 and R2 0,153. However, stratification analysis with hypertension, DM, CRP, and D-dimer as covariates shows statistically significant decrease in eGFR with P-value < 0,05.

Conclusion. Patients with risk factors such as hypertension, diabetes melitus, higher CRP and D-dimer value should be monitored closely by checking the creatinine and urine output regularly."

"ABSTRAKTujuanPenelitian mengenai penggunaan analisis faktor risiko dan mortalitas pada operasijantung masih menjadi perdebatan dan merupakan area yang sedang berkembang.Analisis faktor risiko dalam penilaian suatu hasil pembedahan jantung merupakan halyang tidak dapat dihindari. Ahli bedah dan rumah sakit memerlukan suatu hasilpenilaian faktor risiko terhadap risiko kejadian mortalitas perioperasi agar dapatmenentukan keputusan klinis. Tujuan penelitian ini adalah untuk membandingkanParsonnet dan European System for Cardiac Operative Risk Evaluation (EuroSCORE)pada pasien yang menjalani perbaikan katup mitral dan memperkirakan faktor-faktorrisiko apa saja yang dapat mempengaruhi mortalitas perioperatif.Pasien dan MetodeDari bulan Januari 2010 sampai dengan bulan Desember 2012, 96 pasien terpilih yangtelah menjalani operasi perbaikan katup mitral menggunakan mesin jantung paru dantelah dilakukan analisis faktor risiko berdasarkan Parsonnet score and EuroSCORE .seluruh faktor risiko dianalisis dengan analisis deskriptif, tabulasi silang, Pearson ChiSquare, dan uji Anova, keduanya juga dianalisis dengan kurva ROCHasilAngka mortalitas riil sebesar 5,2 %. Berdasarkan Parsonnet score, nilai prediksimortalitas sebesar 18,26 % sementara pada EuroSCORE nilai prediksi mortalitassebesar 3,68 %. Hasil keduanya signifikan secara statistik. Nilai prediksi EuroSCORElebih mendekati angka kematian riil bila dibandingkan Parsonnet score .KesimpulanEuroSCORE lebih unggul dibandingkan dengan Parsonnet score .Nilai prediksiEuroSCORE lebih mendekati angka kematian riil . EuroSCORE merupakan alat ukuryang baik dalam analisis faktor risiko dan mortalitas pada operasi perbaikan katupmitral

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ABSTRACTObjectiveThe use of risk stratified mortality studies for analyzing surgical outcome in cardiacsurgery is obviously a developing area. Unfortunately, outcomes research in valverepair surgery has been relatively limited. The risk stratification in the assessment ofcardiac surgical results is inevitable. Surgeons and hospitals need availability of riskassessment result which may influence decision-making. Without risk stratification,surgeons and hospitals treating high-risk patients will appear to have worse resultsthan others. Our purpose was to compare the performance of risk stratification models,Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE)in our patients undergoing mitral valve repair (MVr) and predict the risk factors thatinfluence inhospital mortality .Patient and methodsFrom January 2010 to December 2012, 96 consecutive patients have undergone MVrusing cardiopulmonary bypass and scored according to Parsonnet score andEuroSCORE algorithm. All risk factors were analyzed by descriptive analytic, crosstabulation, Pearson Chi Square, and Anova test, both scores analyzed by ROC curve.ResultsOverall hospital mortality was 5,2 %. In Parsonnet model, predicted mortality was18,26 % while in the EuroSCORE model, predicted mortality was 3,68 %. and it wasstatistically significant for the Parsonnet score and EURO score . Parsonnet Score hasa higher sensitivity compared to the EuroSCORE. From the ROC curve, AUC forParsonnet score (0,905) higher than AUC for EuroSCORE (0,892). Problems with theParsonnet score of subjectivity, inclusion of many items not associated with mortality,and the overprediction of mortality have been highlighted. Pre operative NYHA class,age, ejection fraction , complication, etiology, EuroSCORE, and Parsonnet scoreduring mitral valve repair were statistically significant for affecting inhospitalmortality risk.ConclusionsThe EuroSCORE is more reasonable overall predictor of hospital mortality in ourpatients undergoing MVr compared to Parsonnet score."

"Renal dysfunction which frequently occurs in type 2 diabetes mellitus patients caused by oxidative stress. The effectiveness of the type 2 diabetes mellitus treatment to renal dysfunction is unknown. This study compare and analyze the correlation between urinary hydrogen peroxide which is a product of oxidative stress and estimated glomerular filtration rate (eGFR) in the treatment groups of sulfonylurea and combination biguanide-sulfonylurea. This study used a retrospective cohort study design with 50 sampels that was taken in Dr. Sitanala Tangerang hospital with total sampling technique. Estimated GFR value obtained based on serum creatinine values were measured using a kinetic Jaffe method, while the urinary hydrogen peroxide using FOX 1 (Ferrous ion Oxidation Xylenol Orange1). Value of urinary hydrogen peroxide in the two treatment groups did not have significant difference (p = 0.69), while the eGFR value of two groups did not have significant differences with the Cockroft Gault is p = 0.884; MDRD p = 0.886; and CKDEPI p = 0.490. Correlation analysis of urinary hydrogen peroxide and eGFR based on the MDRD equation and CKDEPI generate significant positive correlation (r = 0.326; p = 0.021) and (r = 0.282; p = 0.047). There is no antioxidant activity in the treatment groups. Urinary hydrogen peroxide may play a role in the pathophysiologic significance of diabetic nephropathy."