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Dian Wahyu Tanjungsari
Perbandingan nilai Diagnostik High Sensitive Troponin T pada jam ke-1 dan Jam ke-3 pada terduga Sindrom Koroner Akut Non Elevasi Segmen ST = Comparison of High Sensitive Troponin T Diagnostic Value at One Hour and 3 hour of Suspect Acute Coronary Syndrome Non ST Elevation
"Sindrom koroner akut (SKA) merupakan salah satu kegawatan kardiovaskular di
Instalasi Gawat Darurat (IGD). Tatalaksana SKA yang ada saat ini membutuhkan waktu
minimal 3 jam untuk menentukan apakah pasien dirawat atau dipulangkan, hal ini akan
berdampak pada kepadatan IGD dan pemborosan biaya perawatan. European Society of
Cardiology merekomendasikan algoritma 0/1 jam pada pasien dengan gambaran EKG
non elevasi segmen ST (NEST) dengan menggunakan high sensitive troponin T (hscTnT)
dalam menegakkan atau penapisan infark miokard akut non elevasi segmen ST
(IMA-NEST). Penelitian ini bertujuan untuk membandingkan nilai diagnostik hs-cTnT
jam ke-1 dan jam ke-3 pada terduga SKA non elevasi segmen ST dengan awitan nyeri
dada kurang dari 6 jam. Desain penelitian potong lintang. Sebanyak 100 subjek
penelitian yang diambil secara konsekutif sampling. Sensitivitas, spesifisitas, nilai
prediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/1 jam secara berurutan
adalah 93,75%, 98,81%, 93,75%, 98,81%, sementara sensitivitas, spesifisitas, nilai
prediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/3 jam secara berurutan
adalah 87,50%, 96,81%, 93,33% 97,65%. Pemeriksaan hs-cTnT 0/1 jam dapat
dipergunakan dalam rule in dan rule out terduga IMA-NEST dengan awitan nyeri dada
kurang dari 6 jam.
Acute coronary syndrome (ACS) is one of the cardiovascular events in an Emergency
Installation (ED). The patients management of ACS required at least 3 hours to
determined whether the patient hospitalized or outpatient, these would increased EDs
crowded and high cost treatment. The European Society of Cardiology recommended a
0/1 hour algorithm in patients with ECG showed non ST segment elevationusing high
sensitive troponin T (hs-cTnT) parameter to rule in or rule out non ST segment
elevation myocard infarct (NSTEMI).We aimed to compare diagnostic values of hscTnT
at the 1st and 3rd hour in NSTEMI with chest pain onset less than 6 hours. Study
design was cross sectional. A total of 100 subjects enrolled by consecutive sampling
method. Sensitivity, specificity, positive predictive value, and negative predictive value
of hs-cTnT 0/1 hours were 93.75%, 98.81%, 93.75%, 98.81%, while sensitivity,
specificity, positive predictive value, and the negative predictive value of hs-cTnT 0/3
hours were 87.50%, 96.81%, 93.33%, 97.65%. Hs-cTnT 0/1 hour test can be used in
rule in and rule out suspect NSTEMI with the chest pain onset less than 6 hours."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T58732
UI - Tesis Membership  Universitas Indonesia Library
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Interleukin-10 serum level in acute coronary syndrome patients
"Tujuan Membandingkan kadar IL-10 pada pasien sindrom koroner akut (SKA) dan pasien dengan penyakit jantung koroner (PJK). Metode Subyek penelitian adalah pasien SKA yang dirawat di ruang rawat jantung intensif RSCM/FKUI, RS Persahabatan, RS MMC, dan RS Medistra Jakarta antara bulan Mei 2005 sampai Mei 2006. Pasien PJK rawat jalan diambil sebagai pembanding. Kadar seru interleukin 10 (IL-10) diukur pada kedua kelompok dengan metode radioimunoassay. Perbandingan kedua kelompok dilakukan dengan uji t-test tidak berpasangan. Untuk mengetahui apakah kadar IL-10 dapat digunakan sebagai prediksi SKA, maka dilakukan juga perhitungan sensitivitas dan spesifisitas IL-10. Hasil Telah dianalisa data dari 146 penderita (84 SKA dan 62 PJK). Kadar IL-10 pada penderita SKA (7.37 pg/mL + 7.81, CI 95% 5.68-9.07) lebih tinggi dibanding dengan penderita PJK (1.59 pg/mL + 1.55, CI 95% 1.2-1.98). Cut-off point optimum untuk kadar IL-10 adalah >1.95 pg/mL, dengan sensitivitas 79.76 % dan spesifisitas 77.42 %. Kesimpulan Kadar IL-10 pada kelompok SKA lebih tinggi secara bermakna dibanding kelompok PJK. Kadar IL-10 cukup baik digunakan sebagai prediksi SKA, walaupun tidak sebaik CRP.
Abstract
Aim To compare plasma IL-10 concentrations in patients with Acute Coronary Syndrome (ACS) with those in Coronary Artery Disease (CAD). Methods ACS patients hospitalized in intensive coronary care unit (ICCU) of Cipto Mangunkusumo Hospital/Faculty of Medicine University of Indonesia (CMH/FMUI), Persahabatan Hospital, MMC Hospital, and Medistra Hospital, Jakarta, between May 2005 and May 2006, were included in this study. The ambulatory CAD patients were taken as comparator. The serum IL-10 level was measured by immunoassay method, and compared by using Independent Student?s t-test. To investigate whether IL-10 serum level could predict ACS, the sensitivity and specificity of this parameter towards SKA in various IL-10 serum levels were calculated as well. Results In this observational study, as many as 146 subjects were analyzed, consisting of 84 ACS patients, and 62 coronary artery disease (CAD). The IL-10 level was higher in the group of ACS patients (7.37 pg/mL + 7.81, CI 95% 5.68-9.07) than that in CAD patients (1.59 pg/mL + 1.55, CI 95% 1.2-1.98). The optimal cut-off point for serum IL-10 level is >1.95 pg/mL, with 79.76 % sensitivity and 77.42 % specificity. Conclusion The IL-10 level was higher in the ACS patients compared to that in CAD patients. Serum IL-10 measurement is a quite superior method to distinguish acute and stable condition, eventhough it is not as good as hsCRP for the same purpose."
[Fakultas Kedokteran Universitas Indonesia, Fakultas Kedokteran Universitas Indonesia], 2009
pdf
Artikel Jurnal  Universitas Indonesia Library
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Bhanu
Peran skor modified ACEF dalam memprediksi kompleksitas lesi koroner pada pasien penyakit ginjal kronik stadium 3 dan 4 dengan sindrom koroner akut = Role of modified ACEF score in predicting severity of coronary lesions in patients with chronic kidney disease stages 3 and 4 with acute coronary syndrome
"ABSTRAK
Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat
tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanya
lebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuah
perangkat yang memiliki peran penting dalam prognosis mortalitas PJK. Skor
mACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.
Informasi tersebut berguna dalam menentukan prioritas tindakan angiografi
koroner.
Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagai
prediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yang
mengalami sindrom koroner akut (SKA).
Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179
subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCM
tahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan dengan
menggunakan Receiver Operating Characteristic (ROC) curves dengan interval
kepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengan
cara menghitung sensitivitas, spesifisitas, RKP, dan RKN.
Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas
90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%.
Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGK
stadium 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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."
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Ahmad Fariz Malvi Zamzam Zein
Pengaruh hiperglikemia admisi terhadap kejadian aritmia selama perawatan pasien sindrom koroner akut = The influence of hyperglycemia at admission on in hospital arrhythmia in patients with acute coronary syndrome
"ABSTRAK
Latar Belakang: Aritmia selama perawatan merupakan komplikasi yang sering
terjadi pada pasien sindrom koroner akut (SKA) sehingga dibutuhkan identifikasi
risiko secara dini.
Tujuan: Mengetahui insidens pasien SKA yang mengalami aritmia selama
perawatan dan mengetahui pengaruh hiperglikemia admisi terhadap kejadian
aritmia selama perawatan pasien SKA.
Metode: Studi kohort retrospektif ini menggunakan rekam medik pasien SKA yang
dirawat di ICCU RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari-31
Desember 2014. Hiperglikemia admisi didefinisikan sebagai kadar gula darah
admisi >140 mg/dL. Kejadian aritmia selama perawatan meliputi aritmia atrium,
takikardia supraventrikular, blok AV derajat tinggi, dan aritmia ventrikel, yang
diidentifikasi dalam tujuh hari pertama perawatan.
Hasil: Terdapat 232 subjek pada penelitian ini. Prevalensi hiperglikemia admisi
adalah 50,43%. Insidens pasien SKA yang mengalami aritmia selama perawatan
adalah 21,55% (IK 95% 16,26-26,84). Analisis bivariat menunjukkan
hiperglikemia admisi terkait dengan peningkatan risiko aritmia selama perawatan
(RR 1,747; IK 95% 1,042-2,930). Tidak terdapat hubungan yang bermakna antara
jenis SKA, diabetes melitus (DM), obesitas, dan hipertensi dengan kejadian aritmia
selama perawatan. Analisis multivariat menunjukkan OR hiperglikemia admisi
setelah penyesuaian adalah 2,852 (IK 95% 1,351-6,024), dengan variabel perancu
DM.
Simpulan: Insidens pasien SKA yang mengalami aritmia selama perawatan adalah
21,55%. 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. "
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Anditha Ratnadhiyani
Pengalaman wanita pasca sindrom koroner akut dalam adaptasi terhadap perubahan kemampuan fungsional = The experiences of women after acute coronary syndrome in adaptation to functional ability changes / Anditha Ratnadhiyani
"ABSTRAK
Nama : Anditha RatnadhiyaniProgram Studi : Magister Ilmu KeperawatanJudul : Pengalaman Wanita Pasca Sindrom Koroner Akut dalam Adaptasi terhadap Perubahan Kemampuan Fungsional Pemulihan pasca sindrom koroner akut mencakup proses adaptasi individu terhadap perubahan kemampuan fungsional. Perkembangan dalam penelitian di bidang kardiovaskular menunjukkan dampak dan prognosis sindrom koroner akut yang lebih buruk pada wanita jika dibanding pria, yang dikaitkan dengan perbedaan dalam persepsi, prediktor klinis, dan status sosioekonomi. Penelitian ini bertujuan untuk mengeksplorasi pengalaman wanita pasca sindrom koroner akut dalam adaptasi terhadap perubahan kemampuan fungsional. Metode kualitatif dengan desain fenomenologi deskriptif digunakan untuk memperoleh gambaran pengalaman sepuluh partisipan dalam penelitian ini. Pengambilan data dilakukan dengan wawancara mendalam, kemudian dilakukan content analysis dengan metode Colaizzi. Teridentifikasi enam tema utama dari penelitian ini yaitu respon ketidaknyamanan setelah mengalami sindrom koroner akut, penurunan kemandirian dan kemampuan melakukan aktivitas sebagai dampak perubahan kondisi fisik, self-adjustment sebagai koping terhadap perubahan kemampuan fisik, revaskularisasi memberikan harapan kesembuhan, pengaruh dukungan terhadap psikologis, dan self-effort untuk memulihkan kemampuan fungsional. Hasil penelitian menunjukkan peran penting faktor psikologis dalam proses adaptasi wanita selama pemulihan, sehingga direkomendasikan peningkatan intervensi yang mendukung psikologis dalam tatalaksana pasien wanita dengan sindrom koroner akut. Kata kunci: adaptasi, kemampuan fungsional, sindrom koroner akut, wanita
ABSTRACT
Name Anditha RatnadhiyaniStudy Program Master of NursingTitle The Experiences of Women after Acute Coronary Syndrome in Adaptation to Functional Ability Changes Adaptation to functional ability changes is part of recovery after Acute Coronary Syndrome ACS . Earlier studies have indicated that women with ACS have worse impact and prognosis. It is associated with perception differences, clinical predictors and socio economy status. The aim of this study is to explore experiences of women after ACS in adaptation to functional ability changes. A qualitative study using phenomenological description design was conducted. Ten women after ACS participated in individual in depth interview. Data were analysed using Colaizzi rsquo s procedural approach. Women rsquo s experiences in adaptation were formulated into six main themes 1 inconvenience response to ACS 2 decrease in autonomy and ability to perform activities as a result of physical changes 3 self adjustment as a mechanism to cope with physical ability changes 4 being recovered by revascularization 5 social support promotes psychological improvement and 6 self efforts to improve functional abilities. This research denotes a major role of psychological factors in women rsquo s adaptation during recovery process. Therefore, developing a psychological based intervention for women after ACS is an important strategy to improve outcomes. Keywords acute coronary syndrome, adaptation, functional ability, women"
2016
T47065
UI - Tesis Membership  Universitas Indonesia Library
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Nanda Iryuza
Sistem penilaian resiko perdarahan pasca intervensi koroner perkutan primer trans-radial pada infark miokard akut dengan elevasi segmen st = Trans radial primary percutaneous coronary intervention bleeding risk score in st segment elevation myocardial infarction
"ABSTRAK
Latar 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.
ABSTRACT
Background 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."
2016
T55655
UI - Tugas Akhir  Universitas Indonesia Library
cover
Brema Suranta Prakarsa Utama P.
Morbiditas pasien usia lanjut lebih rendah dengan bedah pintas arteri koroner off-pump dibandingkan konvensional = Lower postoperative morbidity with off pump coronary artery bypass grafting surgery in elderly
"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
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"
Depok: Universitas Indonesia, 2017
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Vera Abdullah
Pengaruh psikoterapi suportif singkat terhadap major adverse cardiovascular events, nilai rasio netrofil-limfosit dan gejala psikis pada pasien sindroma koroner akut yang dirawat di Intensive Cardiac Care Unit. = Influence of brief supportive psychotherapy in major adverse cardiovascular events, neutrophil-lymphocyte ratio and psychological symptoms in acute coronary syndrome patients in Intensive Cardiac Care Unit
"ABSTRAK
Latar 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.
ABSTRACT
Background 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."
Fakultas Kedokteran Universitas Indonesia, 2020
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Randy Elbert
Faktor-Faktor yang Berhubungan dengan Kejadian Penyakit Kardiovaskular pada Penduduk Usia Produktif di Daerah Istimewa Yogyakarta (Analisis Data Riskesdas 2018) = Factors Associated with Cardiovascular Disease in Productive Age Population in Special Region of Yogyakarta (Data Analysis of Riskesdas 2018)
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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.

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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Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2023
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Irman Firmansyah
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien pasca Sindroma Koroner Akut = Difference between Plasma Serotonin and Salivary Cortisol with Depressive Symptoms in Post-Acute Coronary Syndrome Patients
"Latar Belakang: Penyakit kardio-serebrovaskular dengan kematian tertinggi sebagian besar diakibatkan Sindroma Koroner Akut (SKA). Dalam perjalanan penyakit tersebut dapat timbul gangguan psikis berupa depresi. Dilaporkan bahwa depresi sering terjadi dan menetap, dengan prevalensi sekitar 20% pada pasien dengan penyakit jantung. Gangguan psikis memiliki hubungan yang erat dengan pengaruh hormonal seperti kortisol dan serotonin. Pada pasien SKA dapat terjadi disfungsi otonom dan disregulasi aksis HPA yang menyebabkan peningkatan kortisol yang dapat memperburuk prognosispasien SKA. Sehingga penting untuk mengetahui pengaruh hormonal yaitu kadar kortisoldan serotonin dalam mengurangi gejala depresi yang akan ditelaah pada penelitian ini. Metode: Penelitian ini merupakan penelitian cross sectional untuk mengetahui peran kortisol dan serotonin terhadap kejadian depresi pada pasien SKA pasca perawatan. Penelitian dilakukan di ICCU RSUPN dr. Cipto Mangunkusumo Jakarta Pusat, Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM dan Divisi Psikosomatik danPaliatif Departemen Ilmu Penyakit Dalam FKUI/RSCM pada 73 orang responden yang memenuhi kriteria inklusi dengan menggunakan wawancara, pengisian kuesioner HADS,pemeriksaan fisik, dan pemeriksaan laboratorium. Hasil: Sebanyak 15,1% pasien SKA mengalami depresi pasca perawatan. Hasil uji statistik antara serotonin plasma terhadapdepresi tidak bermakna secara statistik dengan p value 0,482, demikian pula dengan kortisol saliva dengan p value 0,275. Namun ditemukan bahwa, kadar rerata hormon serotonin pada pasien SKA dalam penelitian ini adalah 189 ng/ml dan kadar rerata kortisol pada pasien SKA pada penelitian ini adalah 2,19 ng/mL. Kesimpulan: Secara statistik, tidak ditemukan perbedaan signifikan antara kadar kortisol terhadap gejala depresi pada pasien paska sindrom koroner akut dengan nilai p-value 0,275. Namun, penelitian ini bermakna secara klinis dilihat dari kadar serotonin plasma yang lebih rendah pada pasien dengan depresi dan lebih tinggi pada pasien yang tidak depresi. Begitu pula dengan kadar kortisol saliva lebih tinggi pada pasien dengan depresi dan lebih rendah pada pasien yang tidak depresi.
Background: Cardio-cerebrovascular disease with the highest mortality is mostly due toAcute Coronary Syndrome (ACS). During the course of the disease, psychological disorders such as depression may happen. It has been reported that depression is commonand persistent, with a prevalence of approximately 20% in patients with heart disease. Psychological disorders have a close relationship with hormones such as cortisol and serotonin. In ACS patients, autonomic dysfunction and dysregulation ofthe HPA axis canoccur and cause an increase in cortisol which can worsen the prognosis of ACS patients. So it is important to know the how hormones, namely cortisol and serotonin in reducing depressive symptoms which will be examined in this study. Methods: This study is a cross-sectional study to determine the impact of cortisol and serotonin in the incidence ofdepression in post-treatment ACS patients. The research was conducted at the ICCU RSUPN dr. Cipto Mangunkusumo Central Jakarta, Division of Cardiology Department ofInternal Medicine FKUI/RSCM and Division of Psychosomatics and Palliative Department of Internal Medicine FKUI/RSCM in 73 respondents who met the inclusion criteria by using interviews, filling out HADS questionnaires, physical examinations andlaboratory tests. Results: A total of 15.1% of ACS patients experienced post-treatment depression. The statistical test results between plasma serotonin and depression were notstatistically significant with a p value of0.482, as well as salivary cortisol with a p valueof 0.275. However, it was found that the average serotonin level in ACS patients in this study was 189 ng/ml and the average cortisol level in ACS patients in this study was 2.19 ng/mL. Conclusion: Statistically, there was no significant relationship between cortisol levels and depressive symptoms in post-acute coronary syndrome patients with a p-valueof 0.275. However, this study is clinically significant in view of the lower plasma serotonin levels in patients with depression and higher in patients who are not depressed.Likewise, salivary cortisol levels were higher in patients with depression and lower in patients who were not depressed."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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