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"Masalah fisik dan emosional masih dialami pasien Sindrom Koroner Akut pascatindakan reperfusi. Ketidakpatuhan dan rasa frustasi dalam menjalankan program prevensi sekunder, berdampak pada tingginya tingkat restenosis dan readmission yang tidak diinginkan. Penelitian ini bertujuan mengidentifikasi efektivitas model asuhan keperawatan mandiri berkelanjutan pada pasien SKA dan pelaku rawat keluarganya terhadap kemampuan perawatan mandiri dan kualitas hidup pasien SKA. Penelitian didesain dalam riset operasional yang terdiri dari 3 tahapan, yaitu tahap studi eksplorasi dengan pendekatan kualitatif, tahap pengembangan model dan tahap uji efektivitas model dengan pendekatan kuantitatif quasy experiment pre-post test with control group pada pasien SKA. Hasil penelitian tahap eksploratif didapatkan tema respons terhadap SKA, faktor risiko dan pendukung perawatan mandiri pasien SKA, dukungan perawatan mandiri pasien SKA, perilaku perawatan mandiri pasien SKA, masalah dukungan upaya perawatan mandiri pasien SKA, kondisi kesehatan pasien SKA pascarawat. Intervensi model efektif meningkatkan kemampuan pelaku rawat keluarga dan kemampuan perawatan mandiri  pasien SKA. Rekomendasi bagi pelayanan keperawatan agar model asuhan keperawatan mandiri berkelanjutan pada pasien SKA dan pelaku rawat keluarganya dapat diimplementasikan sebagai pendekatan asuhan keperawatan pada pasien SKA.

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Physical and emotional problems are experienced by patients with Acute Coronary Syndrome after reperfusion. Non-compliance and frustration in carrying out secondary prevention programs, have an impact on high rates of restenosis and unwanted readmission. This study aims to identify the effectiveness of the continuous independent nursing care model for ACS patients and their family caregivers on the ability of self-care and the quality of life of ACS patients. The research was designed in operational research which consisted of 3 stages, namely the exploratory study phase with a qualitative approach, the model development phase and the model effectiveness test phase with a quasi-experimental quantitative approach pre-post test with control group in ACS patients. The results of the exploratory stage of the study found that the theme of response to ACS, risk factors and support for self-care for ACS patients, support for self-care for ACS patients, self-care behavior of ACS patients, problems with supporting efforts to self-care ACS patients, health conditions of post-treatment ACS patients. The intervention model affects the ability of family caregivers, depression scores, self-care abilities and quality of life of ACS patients. Recommendations for nursing services so that the sustainable independent nursing care model for ACS patients and their family caregivers can be implemented as an approach to nursing care for ACS patients."

"Masalah fisik dan emosional masih dialami pasien Sindrom Koroner Akut pascatindakan reperfusi. Ketidakpatuhan dan rasa frustasi dalam menjalankan program prevensi sekunder, berdampak pada tingginya tingkat restenosis dan readmission yang tidak diinginkan. Penelitian ini bertujuan mengidentifikasi efektivitas model asuhan keperawatan mandiri berkelanjutan pada pasien SKA dan pelaku rawat keluarganya terhadap kemampuan perawatan mandiri dan kualitas hidup pasien SKA. Penelitian didesain dalam riset operasional yang terdiri dari 3 tahapan, yaitu tahap studi eksplorasi dengan pendekatan kualitatif, tahap pengembangan model dan tahap uji efektivitas model dengan pendekatan kuantitatif quasy experiment pre-post test with control group pada pasien SKA. Hasil penelitian tahap eksploratif didapatkan tema respons terhadap SKA, faktor risiko dan pendukung perawatan mandiri pasien SKA, dukungan perawatan mandiri pasien SKA, perilaku perawatan mandiri pasien SKA, masalah dukungan upaya perawatan mandiri pasien SKA, kondisi kesehatan pasien SKA pascarawat. Intervensi model efektif meningkatkan kemampuan pelaku rawat keluarga, kemampuan perawatan mandiri dan kualitas hidup pasien SKA. Rekomendasi bagi pelayanan keperawatan agar model asuhan keperawatan mandiri berkelanjutan pada pasien SKA dan pelaku rawat keluarganya dapat diimplementasikan sebagai pendekatan asuhan keperawatan pada pasien SKA.

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Physical and emotional problems are experienced by patients with Acute Coronary Syndrome after reperfusion. Non-compliance and frustration in carrying out secondary prevention programs, have an impact on high rates of restenosis and unwanted readmission. This study aims to identify the effectiveness of the continuous independent nursing care model for ACS patients and their family caregivers on the ability of self-care and the quality of life of ACS patients. The research was designed in operational research which consisted of 3 stages, namely the exploratory study phase with a qualitative approach, the model development phase and the model effectiveness test phase with a quasi-experimental quantitative approach pre-post test with control group in ACS patients. The results of the exploratory stage of the study found that the theme of response to ACS, risk factors and support for self-care for ACS patients, support for self-care for ACS patients, self-care behavior of ACS patients, problems with supporting efforts to self-care ACS patients, health conditions of post-treatment ACS patients. The intervention model affects the ability of family caregivers, depression scores, self-care abilities and quality of life of ACS patients. Recommendations for nursing services so that the sustainable independent nursing care model for ACS patients and their family caregivers can be implemented as an approach to nursing care for ACS patients."

"Prevalensi Sindrom Koroner Akut (SKA) yang merupakan penyakit jantung iskemik paling kritis menjadi sumber utama morbiditas dan mortalitas di seluruh dunia, meningkat secara signifikan setiap tahunnya di Indonesia termasuk Bali pada kelompok usia dewasa muda. Identifikasi faktor resiko yang bisa dimodifikasi seperti kebiasaan merokok, mengonsumsi minuman beralkohol dan makanan olahan yang membudaya menjadi bagian penting untuk pembuatan strategi pencegahan primer, terjadinya serangan dan pencegahan sekunder mengurangi readmision. Penelitian ini bertujuan mengidentifikasi faktor yang dapat dimodifikasi berhubungan dengan kejadian SKA usia dewasa muda di Bali. Penelitian kuantitatif ini menggunakan desain cross sectional dengan studi deskriptif-analitik, dan teknik consecutive sampling pada 150 responden sesuai kriteria inklusi. Hasil penelitian menunjukkan terdapat hubungan signifikan antara Hipertensi, Diabetes Mellitus, Dislipidemia, Hiperuresemia, Diet, Aktivitas fisik, Obesitas, Merokok, Konsumsi Alkohol, Stres, dan Kualitas Tidur. Faktor yang paling berhubungan dengan kejadian SKA pada dewasa muda di Bali adalah Hipertensi (OR=6,785). Rekomendasi diharapkan penelitian lanjutan terkait faktor lain yang dapat mempengaruhi kejadian SKA dewasa muda di Bali seperti kardiososial serta strategi pencegahan dan pengendalian berbasis budaya Bali.

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The prevalence of acute coronary syndrome (ACS), which is the most critical ischemic heart disease and the main source of morbidity and mortality in the world, it increases significantly every year in Indonesia, including young adult in Bali. Modifiable risk factors, such as the habit smoking habits, consuming alcohol drinks and processed foods is an important part of primary prevention strategy of attacks and secondary prevention of reducing readmissions. This study aims to identify modifiable factors that are associated with the incidence of acute coronary syndrome (ACS) in young adults in Bali. This quantitative research used a cross-sectional design with a descriptive-analytic study and a consecutive sampling technique on 150 respondents according to the inclusion criteria. Data analysis used descriptive analysis, chi-square test, and logistic regression. The results showed that there was a significant association between Hypertension, Diabetes Mellitus, Dyslipidemia, Hyperurecemia, Diet pattern, Physical activity, Obesity, Smoking, Alcohol consumption, Stress, and Sleep Quality. The most factor associated with the incidence of ACS in young adults in Bali is hypertension (OR=6.785). Recommendations for further research regarding other factors that can affect the incidence of ACS such as cardio-social in young adults in Bali as well as prevention and control strategies based on Balinese culture."

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

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

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

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

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

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

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

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

"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."

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

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

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

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

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

"Berduka dapat dirasakan oleh pasien SKA yang kehilangan kondisi sehatnya secara tiba-tiba. Berduka bisa menjadi rumit sehingga dapat menurunkan kepatuhan pasien terhadap pengobatan dan meningkatkan resiko kejadian infark berulang dan rehospitalisasi. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan berduka pada pasien yang dirawat pasca SKA. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif analitik, menggunakan pendekatan cross sectional yang melibatkan 132 responden. Analisis data menggunakan analisis deskriptif, uji chi square dan regresi logistik berganda. Karakteristik sosiodemografik responden menunjukkan bahwa sebagian besar berjenis kelamin laki-laki, berpendidikan tinggi, aktif bekerja, dan berstatus menikah. Responden dengan usia ≤ 60 tahun dan > 60 tahun memiliki proporsi yang sama. Berdasarkan karakteristik klinis, sebagian besar responden menjalani rawat inap ≤ 5 hari, tidak memiliki riwayat SKA, memiliki ko-morbid, dan memiliki keterbatasan mobilitas fisik. Sebagian besar responden memiliki dukungan keluarga baik, kecerdasan spiritual baik dan persepsi terhadap penyakit negatif. Hasil dari penelitian ini menunjukkan bahwa sebagian besar responden mengalami berduka yang tinggi. Terdapat hubungan yang signifikan antara ko-morbid (p=0.028), keterbatasan mobilitas fisik (p=0.031), kecerdasan spiritual (p=0.022), dan persepsi terhadap penyakit (p=0.004), dimana persepsi terhadap penyakit adalah faktor yang paling dominan berhubungan dengan berduka, dengan OR 3.362 (CI 95% 1.389-8.134). Pentingnya intervensi keperawatan untuk meningkatkan persepsi terhadap penyakit dan mencegah terjadinya berduka tinggi yang memanjang dan rumit pada pasien SKA.

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Grief can occur in ACS patients who suddenly lose their healthy condition. Grieving can be complicated and can reduce patient compliance with treatment and increase the risk of recurrent infarction and rehospitalization. This study aims to determine factors associated with grieving among hospitalized patients after ACS event. This research is a quantitative research with a descriptive analytical design, using cross sectional approach involving 132 respondents. Data analysis used descriptive analysis, chi-square test and multiple logistic regression. The sociodemographic characteristics of the respondents showed that the majority were men, highly educated, actively working, and married. Respondents aged ≤ 60 years and > 60 years have the same proportion. In clinical characteristics, most of the respondents were hospitalized for ≤ 5 days, had no history of ACS, had co-morbidities, and had limited physical mobility. Most respondents had good family support, good spiritual intelligence and negative perceptions of illness. The results of this research show that the majority of respondents experienced high levels of griving. There is a significant relationship between co-morbidity (p= 0.028), limited physical mobility (p=0.031), spiritual intelligence (p=0.022) and perception of illness (p=0.004), where perception of the illness is the most dominant factor related to grief, with OR 3.362 (CI 95% 1.389-8.134). It is important to provide nursing interventions to improve perceptions of illness and prevent prolonged and complicated grief in ACS patients."

"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."

"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. "