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"Background: chronic kidney disease (CKD) increases the severity and risk of mortality in acute coronary syndrome (ACS) patients. The role of β2-M as a filtration and inflammation marker and FGF23 as a CKD-MBD process marker might be significant in the pathophysiology in ACS with CKD patients. This study aims to determine the association of β2-M and FGF23 with major adverse cardiac event (MACE) in ACS patients with CKD. Methods: we used cross sectional and retrospective cohort analysis for MACE. We collected ACS patients with CKD consecutively from January until October 2018 at Dr. Cipto Mangunkusumo General Hospital. Data were analyzed using logistic regression and Cox's Proportional Hazard Regression. Results: a total of 117 patients were selected according to the study criteria. In bivariate analysis, β2-M, FGF23, and stage of CKD had significant association with MACE (p = 0.014, p = 0.026, p = 0.014, respectively). In multivariate analysis, β2-M - but not FGF 23- was significantly associated with MACE (adjusted HR 2.16; CI95% 1.15-4.05; p = 0.017). Conclusion: β2-M was significantly associated with MACE, while FGF23 was not so. This finding supports the role of inflammation in cardiovascular outcomes in ACS with CKD patient through acute on chronic effect."

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

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

"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. "

"This case study aim to evaluate the response of steroid treatment for autoimmune endocarditis. Valvular heart disease is relatively rising in both congenital and acquired cases, but the autoimmune endocarditis remains rare. In this case, a 34 year old woman with clinical manifestation resembling systemic lupus erythematosus (SLE) is diagnosed with Libman-sacks Endocarditis. After six months of steroid treatment, her clinical manifestations and heart structure improved.

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Laporan kasus ini bertujuan untuk mengevaluasi respons terapi steroid pada endokarditis autoimun. Insidens penyakit jantung katup mengalami peningkatan dengan berbagai macam penyebab mulai dari kongenital sampai yang didapat, tetapi yang disebabkan oleh autoimun sangat jarang. Laporan kasus ini menyajikan kasus wanita, 34 tahun, dengan gejala dan tanda mirip lupus eritematosus sistemik (LES). Pada pemeriksaan penunjang didapatkan data yang mendukung adanya penyebab autoimun dan mengenai organ jantung. Pasien didiagnosis Libman-Sacks Endocarditis dan diberikan terapi steroid. Pasien mengalami perbaikan klinis dan struktural jantung setelah mendapatkan terapi selama 6 bulan."

"The purpose of this case repots are to evaluate the role of ST elevation in aVR lead and to make analysis between both cases. There are some atypical electrocardiogram (ECG) presentations which need prompt management in patient with ischemic clinical manifestation such as ST elevation in aVR lead. In this case study, we report a 68-year old woman with chief symptoms of shortness of breath and chest discomfort. She was diagnosed with cardiogenic shock, with Killip class IV, and TIMI score of 8. The second case is a 57-year-old man with typical chest pain at rest which could not be relieved with nitrate treatment. He was diagnosed with ST elevation in inferior and aVR lead, and occlusion in left circumflex artery (LCX). Both patients underwent primary percutaneous coronary intervention (PPCI). Subsequently, both cases presented remarkable clinical improvements and improved ST elevation myocardial infarction (STEMI) in aVR lead.

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Laporan kasus ini bertujuan menilai peran ST elevasi di lead aVR dan manifestasi perbedaannya diantara dua kasus. Ada beberapa tanda elektrokardiogram (EKG) yang tidak khas yang membutuhkan manjemen segera pada pasien dengan manifestasi klinis iskemia seperti elevasi ST di sadapan aVR. Pada laporan ini kami, menyajikan seorang wanita, 68 tahun mengalami sesak napas dan tidak nyaman di dada, dan diagnosis syok kardiogenik dan edema paru, elevasi ST di anterior luas dan sadapan aVR, dan oklusi left artery descendent (LAD) dan left circumflex artery (LCX) dengan killip 4 dan skor thrombolysis in myocardial infarction (TIMI) 8. Kasus kedua, seorang pria, 57 tahun mengeluh nyeri dada khas saat istirahat, 2 jam sebelum ke RS. Tidak hilang dengan nitrat. elevasi ST di sadapan inferior dan aVR, dan oklusi di LCX. Kedua pasien dilakukan primary percutaneous coronary intervention (PPCI) dan mengalami perbaikan kondisi serta perbaikan ST elevation in Myocardial infarction (STEMI) di sadapan aVR."

"Background: 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.

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Latar belakang: menemukan faktor-faktor lain selain TIMI skor yang dapat dijadikan sebagai predictor mortalitas 30 hari pada pasien ST-elevation myocardial infarction (STEMI) dengan memasukkan variabel laju filtrasi glomerulus dan variabel fraksi ejeksi ventrikel kiri (FEVK) di Rumah Sakit Umum Pusat Nasional (RSUPN) Cipto Mangunkusumo.

Metode: studi kohort retrospektif terhadap 487 pasien STEMI yang dirawat di RSUPN Cipto Mangunkusumo pada periode 2004-2013. Besar sampel dihitung dengan menggunakan rumus rule of thumbs. Data diperoleh dari penelusuran rekam medis dan dianalisis secara bivariat dan multivariat menggunakan Cox’s Proportional Hazard Regression Model. Setelah itu, sebuah model sistem skor baru dibuat untuk memperkirakan tingkat mortalitas 30 hari pada pasien STEMI. Kemampuan kalibrasi dan diskriminasi dari model sistem skor baru ditinjau dengan menggunakan uji Hosmer-Lemenshow dan AUC (area under receiver operating characteristic curve).

Hasil: analisis secara bivariat dan multivariat menunjukkan bahwa hanya dua variabel yang secara statistik bermakna dalam model sistem skor baru yaitu kelas Killip II-IV dan LFG dengan kisaran total skor 0 hingga 4.6. Klasifikasi risiko mortalitas dalam 30 hari pada pasien STEMI adalah tinggi (total skor >3,5; 46,5%), sedang (total skor 2,5-3,5;23,2%), dan rendah (total skor <2,5;5,95%). Dua variable skor ini memiliki kalibrasi (p >0,05) dan diskriminasi (AUC 0.816; IK 95%; 0.756-0.875) yang memuaskan.

Kesimpulan: terdapat dua variabel skor baru yang dapat dijadikan sebagai prediktor risiko mortalitas 30 hari pada pasien STEMI, yaitu kelas Killip dan LFG. Dua variabel skor ini memiliki kalibrasi dan diskriminasi yang baik"