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Abstrak :
ABSTRACT
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.

Abstrak :
Latar Belakang. Stratifikasi risiko merupakan bagian integral dari managemen pasien sindrom koroner akut (SKA). Identifikasi pasien yang berisiko tinggi menjadi sangat penting untuk meningkatkan kewaspadaan sekaligus mengurangi tindakan berlebih terhadap pasien dengan risiko rendah. Meskipun TIMI pada STEMI dan UAPINSTEMI merupakan skor risiko yang baik dan telah divalidasi dan dipergunakan secara luas, tetapi penelitian mengenai perfonnanya belum pernah dilakukan di Indonesia. Adanya perbedaan karakteristik antara pasien SKA di Indonesia dengan populasi di negara maju dapat mempengaruhi prognosis pasien sehingga perlu dilakukan penelitian mengenai perfonna dari kedua sistem skoring tersebut. Tujuan. Menilai perfonna kalibrasi dan diskriminasi skor TIMI dalam memprediksi mortalitas 30 hari pasien STEMI dan 14 hari pasien UAPINSTEMI di Indonesia Metodologi. Studi kohort retrospektif menggunakan data rekam medis pasien SKA yang dirawat di IeeU RSeM 2003-2010 dengan metode pengambilan sampel konsekutif. Perfonna kalibrasi skor TIMI dinyatakan dengan plot kalibrasi dan uji Hosmer-Lemeshow sedangkan perfonna diskriminasi dinyatakan dengan nilai AUe. Hasil. Selama penelitian terkumpul 714 pasien STEMI dan 787 pasien UAPINSTEMI yang dirawat di IeeU RSeM. Skor TIMI STEMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dengan plot kalibrasi 0,98, uji Hosmer-Lemeshow 0,93 dan nilai AUe 0,801 (Kl 95% 0,759-0,844). Perfonna kalibrasi dan diskriminasi skor TIMI UAPINSTEMI juga cukup baik dengan plot kalibrasi mencapai 0,88, uji Hosmer lemeshow 0,86 dan nilai AUe 0,727 (KI95% 0,668-0,786). Simpulan. Skor TIMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas pasien SKA di Indonesia. ......Background. Risk Stratification in acute coronary syndrome patients is an integral part in the management of patients. Risk stratification is important to avoid overtreatment in high risk patients, as well as undertreatment in low risk patients. Although TIMI STEMI and TIMI UAiNSTEMI are scores that have been validated and used widely, but to date no study of its appicability has been done in Indonesia. Differences in characteristic of acute coronary syndrome patients in Indonesia compared to developed countries can have influence on the prognostic of the patient hence a study is needed regarding performance of TIM I scoring system. Objectives. To obtain the calibration dan discrimination performance of TIMl risk score to predict 30 day dan 14 day mortality in STEMI and UAPINSTEMI patients in Indonesia Methods. A retrospective cohort study with consecutive sampling was done in ACS patients hospitalized in the ICCU Cipto Mangun Kusumo Hospital between the period 2003 until 2010. Calibration performance of TIM I risk score was evaluated by calibration plot and Hosmer-Lemeshow test while discrimination performance was done with A Uc. Results. A total of 714 STEMI patients and 787 UAPINSTEMI patients entered the study. TIMI STEMI risk score have a good calibration and discrimination performance with calibration plot of 0, 98, Hosmer-Lemeshow test 0,93 and AUC 0,801 (CI95% 0,759-0,844). A good calibration and discrimination performance of TIMI UAPINSTEMI risk score was observed with calibration plot of 0,88, Hosmer-Lemeshow test 0,86 and AUC 0,73 (CI 95% 0,668-0,786). Conclusion. TIM! risk score has a good calibration and discrimination performance in predicting mortality of ACS patients in Indonesia.

Abstrak :
ABSTRAK
Latar belakang Penyakit 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. Tujuan Memodifikasi 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). Hasil Dari 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. Kesimpulan Modifikasi 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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ABSTRACT
Background Coronary 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. Objective To 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). Results From 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%. Conclusion Modified 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.