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"Latar Belakang:Keterlambatan penanganan pasien STElevation Myocardial Infarction(STEMI)menjadi penyebab tingginya mortalitas dan kejadian MACE (Major Adverse Cardiac Events). Di Indonesia, pasien pasien STEMI sering mengalami keterlambatan penanganan. Upaya yang dapat dilakukan di fasilitas kesehatan dengan kemampuan Primary Percutaneous Coronary Intervention(PCI) adalah mencapai reperfusi tepat waktu pasien STEMI. Berbagai strategi dilakukan untuk mencapai reperfusi tepat waktu diantaranya dengan menerapkan program CODE STEMI. Program CODE STEMI merupakan notifikasi STEMI melalui sistem panggilan tunggal yang dapat mempercepat waktu reperfusi pasien STEMI di rumah sakit.Tujuan:Mengetahui pengaruh penerapan program CODE STEMI terhadap Door to Balloon Time (D2BT) dan MACE pasien STEMI yang menjalani PrimaryPCI di RSUPN Cipto Mangunkusumo Jakarta.Metode:Penelitian ini merupakan studi kohort retrospektif pada 255 rekam medis pasien STEMI yang menjalani PrimaryPCI di RSUPN Cipto Mangunkusumo sebelum penerapan program CODE STEMI (2015-2016) dan sesudah penerapan program CODE STEMI (2017-2018). Analisis data dilakukan secara kuantitatif dengan uji Mann whitney untuk D2BT dan chi square untuk MACE.Hasil:Terdapat 111 pasien pada kelompok Non CODE STEMI dan 144 pasien pada kelompok CODE STEMI. D2BT berkurang bermakna 110 menit dari 275 (99-2356) menit pada kelompok Non CODE STEMI menjadi 165 (67-1165) menit pada kelompok CODE STEMI (p <0.001). Kejadian MACE (48,4% vs 51,6%; p = 0,120), gagal jantung (46,6% vs 42 %; p = 0,288), syok kardiogenik (27% vs 19,4%; p = 0,152), aritmia (12,6% vs 6,2%; p = 0,079), stroke (4,5% vs 5,6%; p = 0,705) dan angka mortalitas (7,2% vs 3,5%; p = 0,179) sama antara kedua kelompok.Kejadian infark berulang dan PCI ulang berkurang bermakna pada kelompok CODE STEMI (4,5% vs 0,7%; p = 0.047, 2,7% vs 0,0%; p = 0.047).Simpulan:Program CODE STEMI memperbaiki D2BT. Program CODE STEMI tidak menurunkan kejadian MACE.

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Background: Delay in the management of ST Elevation Myocardial Infarction (STEMI)patients is a cause of high mortality and the incidence of Major Adverse Cardiac Events (MACE).In Indonesia, STEMI patients often experience delays in treatment. Efforts that can be made in health facilities with Primary PercutaneousCoronary Intervention(PCI)capability are achieving timely reperfusion of STEMI patients. Various strategies were carried out to achieve timely reperfusion including implementationthe CODE STEMI program. The CODE STEMI program is a STEMI notification through a single call system that can speed up the reperfusion time of STEMI patients in the hospital.

Objective:To determine the effect of the implementation of the CODE STEMI program on Door to Balloon Time (D2BT) and MACE of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital Jakarta.

Methods: This was a retrospectivecohort study on 255 medical records of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital before the application of the CODE STEMI program (2015-2016) and after the application of the CODE STEMI program (2017-2018). Data analysis was performed quantitatively by Mann Whitney test for D2BT and chi square for MACE

Results:There were 111 patients in the Non CODE STEMI group and 144 patients in the CODE STEMI group. D2BT decreased significantly 110 minutes from 275 (99-2356) minutes in the Non CODE STEMI group to 165 (67-1165) minutes in the CODE STEMI group (p <0.001). MACE events (48.4% vs 51.6%; p= 0.120), heart failure (46.6% vs 42%; p = 0.288), cardiogenic shock (27% vs 19.4%; p = 0.152), arrhythmia (12.6% vs 6.2%; p = 0.079), stroke (4.5% vs 5.6%; p = 0.705) and mortality rate (7.2% vs 3.5%; p = 0.179 ) were similar between the two groups. The incidence of reinfarction and repeated PCI was significantly reduced in the CODE STEMI group (4.5% vs 0.7%; p = 0.047, 2.7% vs 0.0%; p = 0.047).C

onclusions:The CODE STEMI program reduces D2BT. The CODE STEMI program did not reduce the overall MACE incidence but reduced the incidence of reinfarction and repeated PCI of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital. "

"ABSTRAKLatar belakang: PCSK9 merupakan protein yang berperan dalam regulasi kadar kolesterol LDL darah. PCSK9 diketahui memiliki mekanisme kerja lain yang melibatkan proses inflamasi, peningkatan Lp(a), aktivasi jaras protrombotik dan platelet, metabolisme triglyceride-rich lipoprotein, serta modifikasi plak yang juga dapat berperan dalam patogenesis berbagai spektrum penyakit aterosklerotik, termasuk IMA-EST. Kemajuan dalam strategi penatalaksanaan IMA-EST telah berhasil meningkatkan kesintasan. Polimorfisme R46L gen PCSK9 diketahui memiliki efek proteksi terhadap risiko kardiovaskular. Pada pasien infark miokard, prevalensi pembawa karier mutan R46L sebesar 2,14%. Dalam observasi pasien infark miokard akut didapatkan proporsi pasien yang memiliki kesintasan yang panjang. Polimorfisme R46L gen PCSK9 dipikirkan dapat memiliki peranan dalam mempertahankan kesintasan pasien-pasien tersebut. Tujuan: Penelitian ini bertujuan untuk mempelajari hubungan antara polimorfisme R46L gen PCSK9 pada pasien IMA-EST yang menjalani IKPP dengan luaran kardioserebrovaskular mayor. Metode: Sebanyak 601 pasien dengan IMA-EST yang menjalani IKPP diperiksakan polimorfisme R46L gen PCSK9 pada saat admisi. Data luaran kardioserebrovaskular mayor dan data penunjang lain didapatkan dari rekam medik dan follow-up melalui telepon. Hasil: Tidak ditemukan varian mutan (GT dan TT) polimorfisme R46L gen PCSK9 pada pasien IMA-EST yang menjalani IKPP sehingga analisa hubungan polimorfisme R46L gen PCSK9 terhadap luaran kardioserebrovaskular mayor tidak dapat dilakukan. Kesimpulan: Pada pasien IMA-EST yang menjalani IKPP di RS Jantung Harapan Kita, tidak ditemukan varian mutan R46L gen PCSK9. Analisa hubungan polimorfisme R46L gen PCSK9 terhadap luaran kardioserebrovaskular mayor tidak dapat dilakukan.

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ABSTRACTBackground: PCSK9 is a protein molecule that regulates serum LDL cholesterol level. Recent data suggest that PCSK9 activity may also work through other mechanisms, such as inflammation, increased Lp(a), triglyceride-rich lipoprotein metabolism, activation of prothrombotic pathways and platelets, and modification of atherosclerotic plaque, which may contribute to the pathogenesis of atherosclerotic diseases, including STEMI. Advances in the management of STEMI have succeeded in increasing survival. Polymorphism R46L of PCSK9 gene has been known to have protective effect on cardiovascular risks. In patients with myocardial infarction, the prevalence of R46L mutation carriers was 2.14%. In the longterm observation of acute coronary syndrome patients, a proportion of patients experienced longer survival. Polymorphism R46L of PCSK9 gene may play a role in longterm survival. Objective: The aim of this study is to evaluate the association between plasma polymorphism R46L of PCSK9 gene with MACCE in STEMI patients who underwent primary PCI. Methods: In total, 601 patients with STEMI who were treated with primary PCI had their plasma sample drawn during admission and evaluated for polymorphism R46L of PCSK9 gene. MACCE and other supportive data were taken from the medical records and telephone follow-up. Results: In this study, no polymorphism R46L of PCSK9 gene was detected. Therefore, its association with MACCE could not be further analysed. Conclusion: There was no polymorphism R46L of PCSK9 gene detected in STEMI patients treated with primary PCI. The analysis of its association with MACCE could not be conducted."

"Latar Belakang : Cedera reperfusi menyebabkan kerusakan dan kematian sel miokard dan memberikan kontribusi hingga 50% dari luas infark. Pengkondisian iskemia dari luar jantung (remote ischemic conditioning, RIC) dapat menjadi perlakuan non invasif, murah dan mudah untuk membatasi cedera reperfusi. Efek kardioprotektif yang didapatkan dari perlakuan ini antara lain penurunan luas infark dan peningkatan fungsi kontraktilitas ventrikel. 6 MWT merupakan salah satu penilaian luaran klinis dan NT pro BNP menjadi salah satu parameter dari penilaian fungsi miokard dari efek RIC. 6 MWT pada sejumlah studi telah menunjukkan hubungannya dengan luas infark. Dalam studi yang lain pemeriksan NT-pro BNP setelah IMA-EST berkorelasi dengan ukuran infark dan fungsi miokard setelah IMA. Tujuan : Menilai efek perlakuan pengkondisian iskemia ekstremitas pada pasien IMA EST yang menjalani IKPP terhadap 6 MWT dan kadar NT-ProBNP. Metode : Penelitian ini merupakan studi klinis acak tersamar dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Dilakukan perlakuan RIC pada kelompok studi sebelum tindakan IKPP. Pengukuran 6 MWT dan kadar NT-ProBNP dilakukan dalam masa perawatan pada kelompok studi dan kontrol. Hasil : Terdapat 87 subyek yang terbagi dalam 2 kelompok yakni 41 orang mendapat perlakuan RIC dan 46 orang sebagai kelompok kontrol. Didapatkan jarak 6 MWT lebih jauh pada kelompok studi dibandingkan dengan kelompok kontrol namun tidak bermakna secara statistik (316 (±46) vs 289 (±66) meter; p = 0.06). Didapatkan kadar NT-Pro BNP lebih rendah pada kelompok studi dibandingkan dengan kelompok kontrol yang bermakna secara statistik (1073 (328-3974) vs 1514 (205-10696) pg/mL; p = 0.05). Kesimpulan : Perlakuan RIC sebelum tindakan IKPP tidak meningkatkan kapasitas fungsional yang diukur dengan 6 MWT namun dapat menurunkan kadar NT-ProBNP.

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Background : Reperfusion injury has been recognized to cause cell damage and death. As consequence, it contributes about 50% of infarct size. Remote ischemic condiotioning (RIC) has been identified as a noninvasive, low-cost, and easy to performed method to prevent it, so cardioprotective effect such as reducing infarct size and ventricular contraction improvement could be achieved. Meanwhile, myocardial function can be clinically assessed by measuring 6 minutes walk test (6MWT) and serum NT-proBNP level. Many studies showed association and correlation among 6MWT, NT-proBNP, infarct size and myocardial function.

Objectives : To assess remote ischemic conditioning in ST-Elevation Myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) to their 6 MWT distance and serum NT-proBNP level.

Methods : Eighty seven subjects were randomly assigned into 2 groups, those receiving RIC intervention (4 to 5 minutes cycles of cuff inflation/deflation on lower extremity) or control (uninflated cuff for 40 minutes) protocols prior to primary PCI. Prior to hospital discharge, all subjects underwent 6MWT and NT-proBNP evaluation.

Results : RIC improve 6MWT distance in intervention group, but it was not significantly different compared to control group (316 ±46 meters vs. 289 ± 66 meters). Serum NT-ProBNP level was also lower in RIC group compared to control group (1073 (328-3974) pg/mL vs. 1514 (205-10696) pg/mL ) and the difference was statistically significant.

Conclusion : RIC intervention prior to primary PCI improved functional capacity measured by 6MWT but not statistically significant compared to control group, however it improved serum NT-ProBNP significantly."

"Latar belakang: micro-RNA saat ini telah diketahui berperan dalam patofisiologi berbagai penyakit termasuk di bidang kardiovaskular. miR-26a platelet dikaitkan dengan aktifitas platelet tinggi.Resistensi klopidogrel telah diketahui memiliki prevalensi yang cukup tinggi di populasi Asia, yang mana dapat mempengaruhi mortalitas serta kejadian kardiovaskular mayor. Hubungan antara ekspresi miR-26a platelet dengan resistensi klopidogrel begitu pula dengan TIMI flow pasca IKPP pada IMA-EST di populasi Asia, belum pernah dilaporkan. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi miR-26a platelet terhadap reaktivitas platelet dan perfusi miokardium pasca IKPP. Metode: Pada pasien IMA-EST yang menjalani IKPP dan mendapatkan terapi dosis loadingklopidogrel 600 mg, dimasukkan kedalam populasi penelitian. Kami mengukur reaktivitas platelet dengan menggunakan VerifyNow P2Y12, aktifitas platelet tinggi didefiniskan jika memiliki nilai > 208 PRU. Metode RealtimePCR Taqman dilakukan untuk analisa ekspresi miR-26a platelet. Ekspresi miR-26a platelet dan reaktivitas platelet dikorelasikan dengan TIMI flowpasca IKPP pada pasien IMA-EST. Hasil: Terdapat 100 subyek yang direkrut pada studi ini. Diantaranya, 59% menunjukkan peningkatan ekspresi miR-26a. Reaktifitas platelet meningkat pada 27 % pasien studi ini dikategorikan non-responder terhadap klopidogrel. Terdapat hubungan antara ekspresi dengan penurunan fungsi penghambatan platelet (OR 4.2, p = 0.006). Indeks reaktivitas platelet >208 PRU meningkatkan risiko TIMI flow < 3 (OR 3.3, p= 0.015). Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIMI flow < 3. Kesimpulan: Pasien dengan peningkatan ekspresi miR-26a platelet memiliki risiko untuk mengalami menjadi non-responderklopidogrel. Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIM flowpasca IKPP.

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Background: micro-RNA has now been known to play a role in the pathophysiology of various diseases including cardiovascular disease. Clopidogrel resistance has been known prevalent in Asian population, that may affect mortality and major cardiovascular events. The relationship between the expression of platelet miR-26a and clopidogrel resistance as well as TIMI flow post primary PCI in STEMI among Asian populations, has never been done.

Objective: the aim of this study is to define whether miR-26a platelet expression has a relation with platelet reactivity and myocardial perfusion after primary PCI.

Methods: STEMI patients who underwent primary PCI and has received 600 mg loading dose of clopidogrel were recruited for the study. We measured platelet reactivity by VerifyNow P2Y12, high platelet reactivity was defined as > 208 PRU. Realtime PCR by taqman method were performed to asses the expression of miR-26a platelet. miRNA-26a platelet expression and platelet reactivity were correlated with TIMI flow post primary PCI in STEMI.

Hasil: there were 100 patients recruited for this study. among them, 59% of patients with high expression of miR-26a platelet. Platelet reactivity showed 27% of the patients were clopidogrel non-responders. There was a relationship between high miR-26a expression and decreased function of platelet inhibition (OR 4.2, p = 0.006). Platelet reactivity index > 208 increased the risk of suboptimal reperfusion (OR 3.3, p = 0.015). There was no direct correlation between miR-26a expression and TIMI flow < 3.

Conclusion: Patients with high miR-26a platelet expression had increased risk of being clopidogrel non responders. There is no direct relationship between miR-26a platelet expression and TIMI flow after primary PCI."

"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. "

"Acute Kidney Injury (AKI) merupakan komplikasi serius yang umum terjadi pada pasien rawat inap. Berdasarkan penelitian tahun 2005, terjadi peningkatan insiden dan keparahan AKI hingga 50% akibat penggunaan obat selama rawat inap. Salah satu tugas apoteker di RS adalah melakukan pemantauan terapi obat, terdapat beberapa obat di RSUI yang dinilai mampu menginduksi terjadinya AKI. Oleh karena itu, dilakukan pembuatan daftar obat yang dapat menginduksi terjadinya AKI serta studi kasus terjadinya AKI pada pasien rawat inap akibat penggunaan obat di RSUI pada bulan Maret 2023. Daftar obat penginduksi AKI dibuat berdasarkan studi literatur dari pustaka tahun 2005 – 2023 kemudian obat dikategorikan berdasarkan kelas terapi obat. Sedangkan, studi kasus dilaksanakan secara retrospektif menggunakan data sekunder pasien rawat inap RSUI pada bulan Maret 2023 yaitu rekam medis salah satu pasien yang memenuhi kriteria inklusi dan eksklusi. Terdapat 26 obat yang mampu menginduksi AKI di RSUI. Berdasarkan studi kasus, terapi ramipril diduga mampu meningkatkan risiko terjadinya AKI pada salah satu pasien RSUI yang dinilai berdasarkan peningkatan nilai serum kreatinin dan penurunan nilai GFR. Ramipril diduga menjadi penyebab peningkatan risiko terjadinya AKI berdasarkan angka prevalensinya sebesar 28%, adanya riwayat perbaikan fungsi ginjal saat penghentian obat, serta fungsi ginjal yang kembali memburuk ketika terapi ramipril kembali dilanjutkan. Penilaian kondisi pasien menggunakan instrumen naranjo dibutuhkan untuk mengonfirmasi insiden terjadinya AKI akibat ramipril.

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Acute Kidney Injury (AKI) was a serious complication that commonly occurs in inpatients. Based on a study in 2005, there was an increase in the incidence and severity of AKI up to 50% due to drug induce during hospitalization. One of the responsibilities of the pharmacist in the hospital was to perform drug therapy monitor and several drugs in RSUI were considered likely to induce AKI. Therefore, a list of drugs induced AKI was created, and a case study of drug-induced AKI in hospitalized patients at RSUI in March 2023 was performed. The list of drugs induced AKI was made based on a literature study from 2005 – 2023, then the drugs were categorized based on the drug therapy class. Meanwhile, the case study was carried out retrospectively using secondary data from hospitalized patients at RSUI in March 2023, which was the medical records from one of the patients who met the inclusion and exclusion criteria. There are 26 drugs-induced AKI in RSUI. Based on the case study, ramipril therapy was thought to be likely to increase the risk of developing AKI in one of the RSUI patients as assessed by the increase of creatinine serum and the decrease GFR values. Ramipril is thought to be the cause of the increased risk of AKI based on its prevalence rate which was 28%, history of improvement in kidney function when stopping the drug, and worsened kidney function when ramipril therapy is resumed. Assessment of the patient's condition using the Naranjo instrument is needed to confirm the incidence of AKI due to ramipril."

"Patient satisfaction was one thing that was very important in reviewing the quality of health services, including health center. Measuring patient satisfaction can be used to evaluate the quality of health services. In this study the dimensions related to health service user satisfaction, were in terms of reliability, assurance, tangible, emphaty and responsiveness. The purpose of this research was to know the level in district of outpatient services and inpatient care at district health center Sidoarjo."

"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."

"ABSTRACTBackground: to identify other factors other than the TIMI scores that can be used as predictors of 30-day mortality in STEMI patients by including variables of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) at Cipto Mangunkusumo National Central General Hospital. Methods: a retrospective cohort study was conducted in 487 STEMI patients who were hospitalized at RSUPN Cipto Mangunkusumo between 2004 and 2013. Sample size was calculated using the rule of thumbs formula. Data were obtained from medical records and analyzed with bivariate and multivariate method using Coxs Proportional Hazard Regression Model. Subsequently, a new scoring system was developed to predict 30-day mortality rate in STEMI patients. Calibration and discrimination features of the new model were assessed using Hosmer-Lemeshow test and area under receiver operating characteristic curve (AUC). Results: bivariate and multivariate analyses showed that only two variables in the new score system model were statistically significant, i.e. the Killip class II to IV and GFR with a range of total score between 0 and 4,6. Thirty-day mortality risk stratification for STEMI patient included high, moderate and low risks. The risk was considered high when the total score was >3,5 (46,5%). It was considered moderate if the total score was between 2,5 and 3,5 (23,2%) and low if the total score was <2,5 (5,95%). Both variables of the score had satisfactory calibration (p > 0,05) and discrimination (AUC 0,816 (0,756-0,875; CI 95%). Conclusion: There are two new score variables that can be used as predictors of 30-day mortality risks for STEMI patients, i.e. the Killip class and GFR with satisfactory calibration and discrimination rate."