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Penyakit kardiovaskular juga merupakan penyebab utama kematian secara global. Di Indonesia, penyakit kardiovaskular mengalami peningkatan prevalensi setiap tahunnya dan menempati peringkat tertinggi sebagai penyebab kematian terutama pada usia produktif. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian penyakit kardiovaskular pada penduduk usia produktif di Daerah Istimewa Yogyakarta berdasarkan data Riset Kesehatan Dasar 2018. Desain studi penelitian ini adalah cross-sectional dengan analisis bivariat. Hasil penelitian menunjukan prevalensi penyakit kardiovaskular pada penduduk usia produktif di Provinsi DI Yogyakarta pada tahun 2018 adalah sebesar 2,7%. Faktor yang berhubungan secaara statistik dengan kejadian penyakit kardiovaskular yaitu umur (POR = 4,615; 95% CI: 3,489-6,104), jenis kelamin (POR = 0,751; 95% CI: 0,566-0,995), tingkat pendidikan (POR = 1,405; 95% CI: 1,064 – 1,855), hipertensi (nilai POR = 2,391; 95% CI: 1,810-3,158), diabetes melitus (POR = 8,531; 95% CI: 5,899 – 12,337), status merokok (POR = 1,979; 95% CI: 1,327-2,950; dan POR = 2,794; 95% CI: 1,738-4,492), obesitas (POR = 1,630; 95% CI: 1,206 - 2,204), aktivitas fisik (POR = 1,968; 95% CI: 1,292 – 2,999), gangguan mental emosional (POR = 2,344; 95% CI: 1,661 – 3,307), konsumsi makanan asin (POR = 0,693; 95% CI: 0,519 – 0,927), dan konsumsi makanan lemak/kolesterol/gorengan (POR = 0,698; 95% CI: 0,517 – 0,944). Sementara itu, konsumsi buah dan sayur serta konsumsi alkohol tidak berhubungan secara statistik dengan kejadian penyakit kardiovaskular. Optimalisasi program pengendalian PTM seperti CERDIK dapat membantu pencegahan kejadian penyakit kardiovaskular.

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Cardiovascular disease is the leading cause of death globally. In Indonesia, cardiovascular disease has an increasing prevalence every year and ranks highest as a cause of death, especially in productive age. This study aims to determine the factors associated with the incidence of cardiovascular disease in the productive age population in the Special Region of Yogyakarta based on data from the 2018 Basic Health Research. The design of this research study was cross-sectional with bivariate analysis. The results showed that the prevalence of cardiovascular disease in the productive age population in Yogyakarta Province in 2018 was 2.7%. Statistically related factors to cardiovascular disease incidence were age (POR = 4.615; 95% CI: 3.489-6.104), sex (POR = 0.751; 95% CI: 0.566-0.995), education level (POR = 1.405; 95% CI: 1.064 – 1.855), hypertension (POR value = 2.391; 95% CI: 1.810-3.158), diabetes mellitus (POR = 8.531; 95% CI: 5.899 – 12.337), smoking status (POR = 1.979; 95% CI: 1.327-2.950; and POR = 2.794; 95% CI:  1.738-4.492), obesity (POR = 1.630; 95% CI: 1.206 - 2.204), physical activity (POR = 1.968; 95% CI: 1.292 – 2.999), mental emotional disorders (POR = 2.344; 95% CI: 1.661 – 3.307), consumption of salty foods (POR = 0.693; 95% CI: 0.519 – 0.927), and consumption of fat/cholesterol/fried foods (POR = 0.698; 95% CI: 0.517 – 0.944). Meanwhile, fruit and vegetable consumption and alcohol consumption were not statistically associated with the incidence of cardiovascular disease. Optimization of NCD control programs such as CERDIK can help prevent cardiovascular disease events

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"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."

"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."

"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."

"ABSTRAKLatar belakang Major adverse cardiovascular events (MACE) masih menjadi target yang dicegah dalam tata laksana sindroma koroner akut (SKA). Rasio netrofil-limfosit (RNL) terkait dengan dampak atau prognosis pada pasien dengan penyakit ini. Kondisi psikologis berperan sebelum, selama dan setelah infark. Psikoterapi suportif singkat (PSS) ditujukan untuk membangun kepercayaan diri, mengurangi cemas dan memperbaiki mekanisme koping terhadap penyakit ini.Tujuan Penelitian ini bertujuan membandingkan pengaruh PSS terhadap MACE, RNL dan gejala psikis pada pasien SKA yang dirawat di Intensive Cardiac Care Unit (ICCU).Metode Penelitian ini merupakan uji klinis random tidak tersamar ganda untuk membandingkan kelompok yang mendapat intervensi PSS dengan kontrol pada pasien SKA yang dirawat di ICCU RSUPN Cipto Mangunkusumo mulai 18 April hingga 30 Juli 2019 terhadap MACE, RNL dan gejala psikis. Intervensi PSS berlangsung 5 sesi selama rawatan di ICCU, kelompok PSS dan kontrol akan difollow-up pada saat sebelum pulang rawatan terhadap MACE (fatal aritmia, infark miokard rekuren, syok kardiogenik dan kematian), RNL dan gejala psikis yang diukur menggunakan inventori Hospital Anxiety Depression Scale (HADS). Data dianalisis menggunakan uji Chi square dan t tidak berpasangan untuk distribusi normal dan uji Fisher dan Mann-Whitney untuk yang tidak terdistribusi normal.Hasil Hasil menunjukkan kelompok PSS terdapat 32 pasien, dan kontrol sejumlah 35 pasien. Median usia sebesar 55 (32-86) tahun. Proporsi lelaki sebesar 74,6%. Rerata lama rawatan ICCU yaitu 5 (2-13) hari. Tidak ada kejadian MACE, namun insiden major adverse event lain (stroke) 3,13% pada PSS dan 5,71% pada kontrol. Rerata RNL kelompok PSS sebesar 3,35(2,26) dan kontrol 3,63(1,79), p 0,346 (95% KI -1,27-0,71). Delta rerata RNL 1,49, p 0,098 (95% KI -0,69 - 3,67); tanpa CHF 3,87(5,48), 0,33(2,54) pada kontrol, p 0,007 d 0,79; tanpa CAD 3,88(4,55), 0,84(2,51) pada kontrol, p 0,014, d 0,77. Rerata skor HAD-Ansietas kelompok PSS sebesar 4,63(3,52) dan kontrol 4,31(2,62), p 0,874 (95% KI -1,19 - 1,82). Delta rerata skor HAD-Ansietas sebesar -0,01, p 0,988 (95% KI -1,74-1,71). Rerata skor HAD-Depresi kelompok PSS sebesar 4,91 (2,63) dan kontrol 4,37 (3,05), p 0,447 (95% KI -0,86 - 1,93). Delta rerata skor HAD-Depresi sebesar 1,62, p 0,149 (95% KI -0,17 -3,41); dengan CHF 1,73(3,58), -1,27(2,8) pada kontrol, p 0,041, d 0,86; dengan CAD 2,08(3,4), -0,8(3,3) pada kontrol, p 0,035, d 0,80.

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ABSTRACTBackground Major adverse cardiovascular events (MACE) is still the preventive target in management acute coronary syndrome (ACS). Neutrophil-lymphocyte ratio (NLR) is regarded to the impact or prognosis in this patients. Psychological conditions play a role before, during and after infarction. Brief supportive psychotherapy (BSP) is stressed in terms of building confidence, reduce anxiety and improve coping mechanisms of this illness.Aim The present study aims to compare influence of BSP on MACE, NLR, and psychological symptom in ACS patients to control one in ICCU.Method The study is a double opened clinical randomized study which was compared with controls before and after intervention to observe the influence of BSP on the patients with ACS who were treated in ICCU of RSUPN Cipto Mangunkusumo - Jakarta in April, 18th to July, 30th 2019 on MACE, NLR and psychological symptom. The BSP intervention was about 5 sessions as long as inpatient in ICCU, the BSP group and the control ones would be followed by the end of the day in ICCU for the MACE (fatal arrhythmias, recurrent myocardial infarction, cardiogenic shock, and death), NLR, and psychological symptom which it was measured with hospital anxiety depression scale (HADS) inventory. Data were analyzed with Chi square and independent t-test for normally distributed data and Fisher and Mann-Whitney test for abnormally ones.Results The study results showed 32 patients in brief supportive psychotherapy group and 35 patients in control one. The median age was 55(32 - 86) years old. The male proportion was 74,6%. The median length of stay in ICCU was 5(2-13) days. There was no MACE, but incident of other major adverse event (stroke) 3,13% in BSP and 5,71% in control. The mean NLR was 3,35(2,26) in BSP group and 3,63(1,79) in control one, p 0,346 (95% CI -1,27 - 0,71). The mean delta of NLR was 1,49, p 0,098 (95% CI -0,69 - 3,67); without CHF 3,87(5,48), 0,33(2,54) in control group, p 0,007 d 0,79; without CAD 3,88(4,55), 0,84(2,51) in control one, p 0,014, d 0,77. The mean of HAD-Anxiety score was 4,63(3,52) in BSP group and 4,31(2,62) in control one, p 0,874 (95% CI -1,19 -1,82). The mean delta of HAD-Anxiety score was -0,01, p 0,988 (95% CI -1,74 - 1,71). The mean of HAD-Depression score was 4,91(2,63) in BSP group and 4,37(3,05) in control one, p 0,447 (95% CI -0,86 - 1,93). The mean delta of HAD-Depression score was 1,62, p 0,149 (95% CI -0,17 - 3,41); with CHF 1,73(3,58), -1,27(2,8) in control group, p 0,041, d 0,86; with CAD 2,08(3,4), -0,8(3,3) in control one, p 0,035, d 0,80. Conclusions There was no MACE, but stroke incident lower in BSP than control one. There was influence of BSP on NLR in ACS patients without CHF or CAD, and psychological symptom in ACS ones with CHF or CAD."

"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."

"Latar BelakangSindrom koroner akut (SKA) masih merupakan salah satu penyebab mortalitas tertinggi di Indonesia. Data Riset Kesehatan Dasar (RISKESDAS) di Indonesia pada tahun 2018 menunjukkan prevalensi penyakit jantung pada penduduk semua umur sebesar 1,5%. Intervensi Koroner Perkutan (IKP) adalah salah satu Teknik revaskularisasi pada SKA. Meskipun dengan adanya IKP, luaran buruk, yaitu Major Adverse Cardiovascular Events (MACE) jangka pendek (30 hari) masih cukup tinggi.TujuanPenelitian ini dilakukan untuk mengetahui prevalensi MACE 30 hari dan faktor prognostik kejadian MACE 30 hari pada pasien SKA yang menjalani IKP serta membuat model prediksinya.MetodeStudi ini menggunakan desain kohort retrospektif dengan jumlah subjek sebesar 424 orang. Pemilihan subjek dilakukan secara konsekutif. Dilakukan analisis bivariat faktor risiko MACE 30 hari (Usia, Diabetes Mellitus, Hipertensi, Status Merokok, Penyakit Ginjal Kronik, Dislipidemia, Multiple Vessel Disease (MVD), Kadar asam urat darah, Fraksi Ejeksi Ventrikel Kiri, TIMI Flow grade, dan Rasio monosit-HDL) termasuk faktor risiko tambahan (Kelas Killip, Left Main Disease (LMD), kadar troponin, dan jenis SKA) lalu dilakukan analisis multivariat pada variabel yang bermakna.HasilDidapatkan MACE 30 hari pada 54 subjek (12,74%). Pada analisis bivariat variabel yang bermakna adalah usia, fraksi ejeksi di bawah 40%, adanya LMD, MVD, peningkatan kelas Killip, dan peningkatan troponin. Model akhir yang didapatkan hanya meliputi kelas Killip dan fraksi ejeksi di bawah 40% dengan AUC 0,774.KesimpulanPrevalensi MACE 30 hari pada pasien SKA paska IKP didapatkan 12,74%. Kelas Killip dan EF di bawah 40% dapat memprediksi kejadian MACE 30 hari pada pasien SKA paska IKP.

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Background

Acute coronary syndrome (ACS) is still one of the highest causes of mortality in Indonesia. Basic Health Research Data (RISKESDAS) in 2018 showed that the prevalence of heart disease in the population of all ages was 1.5%. Percutaneous Coronary Intervention is one of the revascularization techniques in ACS. Despite the existence of Primary Coronary Intervention (PCI), adverse outcomes, collectively known as Major Adverse Cardiovascular Events (MACE) of 30 days are still quite high.

Objective

To determine the prevalence of 30 days MACE and prognostic factors and prediction model for the incidence of 30-day MACE in ACS patients undergoing PCI.

Method

This is a retrospective cohort study with a total of 424 subjects. Subject selection was carried out consecutively. A bivariate analysis of 30-day MACE risk factors (Age, Diabetes Mellitus, Hypertension, Smoking, Chronic Kidney Disease, Dyslipidemia, Multiple Vessel Disease (MVD), Uric Acid, Left Ventricle Ejection Fraction, TIMI Flow grade, and Monocyte-HDL ratio) including additional risk factors (Killip class, Left Main Disease (LMD), Troponin, and ACS type) was carried out and then a multivariate analysis was carried out on significant variables.

Results

Thirty-day MACE was found in 54 subjects (12.74%). In the bivariate analysis the significant variables were age, ejection fraction below 40%, presence of LMD, MVD, increased Killip class, and increased troponin. The final model obtained only includes the Killip class and an ejection fraction below 40% with an AUC of 0.774.

Conclusion

Prevalence of 30 days MACE I post PCI procedure patients were 12,74%. Killip class and EF below 40% can predict 30-day MACE events in ACS patients post PCI procedure."

"Latar belakang: Bedah pintas arteri koroner konvensional memiliki angka morbiditas pascaoperasi yang tidak rendah pada populasi rentan seperti pasien usia lanjut, yang dipercaya disebabkan oleh penggunaan mesin jantung paru. Studi ini bertujuan untuk membandingkan morbiditas pascaoperasi bedah pintas arteri koroner konvensional dan off-pump pada pasien penyakit jantung koroner usia lanjut. Metode: Studi ini menggunakan desain kohort yang dilakukan terhadap 192 subjek yang telah menjalani BPAK elektif tanpa penyakit jantung lainnya di Rumah Sakit Jantung Harapan Kita. Karakteristik demografis dan klinis, luaran pascaoperasi serta morbiditas dikumpulkan secara konsekutif dan dianalisis. Hasil: Durasi intubasi 620 vs 840 menit, durasi penggunaan obat inotropik 1,5 vs 27,5 jam, jumlah transfusi PRC 0 vs 210,5 mL dan jumlah penggunaan obat inotropik 53,4 vs 76,5 secara signifikan lebih rendah pada kelompok off-pump p

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Backgrounds On pump coronary artery bypas graft CABG has unfavorable postoperative morbidity in elderly patients, as the effect of the use of cardiopulmonary bypass CPB machine. The purpose of this study is to compare postoperative morbidities in elderly patients undergoing CABG with and without CPB. Methods This is a cohort study on 192 elderly patients undergoing solitary elective CABG in our hospital. Demographical and clinical characteristics, early postoperative outcomes and morbidities were consecutively gathered from the medical records and then analised. Results Intubation time 620 vs 840 minutes, duration of inotropic drugs given 1.5 vs 27.5 hours, amount of packed red cell PRC given 0 vs 210.5 mL, and amount of inotropic grugs given 53.4 vs 76.5 are significantly lower in the off pump group p"

"Pendahuluan. Sindrom koroner akut (SKA) adalah gangguan yang mengancam jiwa yang tetap menjadi sumber morbiditas dan mortalitas yang tinggi meskipun ada kemajuan dalam pengobatan. Hubungan antara asam urat serum dengan penyakit jantung iskemik masih kontroversial dan belum ditetapkan sebagai faktor risiko kardiovaskular. Interaksi kooperatif antara keduanya tidak sepenuhnya dipahami. Beberapa bukti epidemiologis hubungan kausal tersebut masih kontroversial. Sering sekali penelitian dengan kasus yang sama dan menggunakan metode yang sama tetapi hasilnya berbeda. Penelitian ini bertujuan untuk melakukan meta analisis untuk mensintesis hasil-hasil penelitian yang berbeda tersebut agar diperoleh data baru yang bersifat kuantitatif dan lebih akurat. Metode. Protokol penelitian didaftarkan dengan PROSPERO (CRD42020210948) dan telaah sistematis mengikuti pedoman preferred reporting items for systematic reviews and meta-analyses (PRISMA), dengan menelusuri studi yang dipublikasikan dalam rentan waktu dari Januari 2010 hingga Mei 2020. Cochrane Library, Ebsco, Medline/PubMed, ProQuest dan Sience Direct adalah sumber dari studi yang dipublikasikan. Meta-analisis dilakukan untuk mensintesis korelasi antara kadar asam urat serum dan keparahan stenosis arteri koroner, menggunakan model efek acak untuk menjelaskan kemungkinan heterogenitas penelitian. Heterogenitas dinilai menggunakan I2, dan meta analisis menggunakan perangkat lunak Comprehensive Meta Analysis Version 3 (CMA3).Hasil. Lima studi (n = 601 pasien) diidentifikasi didapatkan korelasi antara kadar asam urat serum dan skor Gensini (r = 0,548; p <0,001) pada pasien SKA. Bias heterogenitas ditemukan dalam analisis, sedangkan bias publikasi tidak ditemukan.Simpulan. Keparahan stenosis arteri koroner pada pasien dengan SKA berkorelasi positif dengan kadar asam urat serum.

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Introduction. Acute coronary syndrome (ACS) is a life-threatening disease which remains a source of high morbidity and mortality despite advances in treatment. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different. This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately.

Methods. The study protocol was registered in PROSPERO (CRD42020210948) and systematic study follows the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA), tracing studies published in January 2010 to May 2020. Sources of database using Cochrane Library, Ebsco, Medline/PubMed, ProQuest and Science Direct. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis. Heterogeneity was assessed using I2, and the meta-analysis was performed using Comprehensive Meta Analysis Version 3 (CMA3) software.

Results. Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis, whereas publication bias was not found.

Conclusion. The severity of coronary artery stenosis in patients with ACS is positively correlated with serum uric acid levels."

"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. "