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"ABSTRAKLatar Belakang. Depresi sering terjadi pada penderita sindroma koroner akut(SKA) dan berhubungan dengan peningkatan mortalitas penderita SKA. Obatselective serotonin reuptake inhibitor (SSRI) telah diketahui efikasinya padadepresi pasca SKA. Nitric oxide (NO) merupakan salah satu penanda fungsiendotel. Studi menunjukkan kemampuan SSRI citalopram dalam memperbaikifungsi endotel melalui peningkatan kadar nitric oxide (NO). Fluoxetinemerupakan obat SSRI yang tersedia dengan baik di Indonesia belum pernahditeliti pengaruhnya pada peningkatan kadar NO.Tujuan. Mengetahui pengaruh pemberian fluoxetine 20 mg/hari selama 8 mingguterhadap peningkatan kadar NO pasien depresi pasca SKA, serta Mengetahuikorelasi antara perbaikan simtom depresi dengan peningkatan kadar NO pasiendepresi pasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu.Metode. Penelitian uji klinik tersamar acak ganda yang dilakukan pada JanuariSeptember2015dipoklinikJantungRSUPDr.SardjitoYogyakarta.Subjekadalahpenderitapasca SKA usia 40-60 tahun yang memenuhi kriteria depresi. Subjekdirandomisasi untuk mendapatkan fluoxetine dosis 20 mg/hari selama 8 mingguatau plasebo. Simtom depresi yang diukur dengan kuesioner BDI dan kadar NOdiambil pada awal dan akhir minggu ke 8 penelitian. Hasil. Dari 44 subjek yang mengikuti penelitian, 24 subjek mendapatkanfluoxetine dan 20 subjek mendapatkan plasebo. Analisis dilakukan pada 19 subjekkelompok fluoxetine dan 19 subjek kelompok plasebo. Rerata kadar NO sebelumdan sesudah pemberian fluoxetine adalah berturut-turut 31,86(2,4) μm dan29,7(2,7) μm. Rerata kadar NO sebelum dan sesudah pemberian plasebo adalahberturut-turut 32,44(2,48) μm dan 30,09(2,87) μm. Tidak terdapat korelasi antara perbaikan simtom depresi dan peningkatan kadar NO pada pasien depresi pasca SKA yang mendapatkan fluoxetine dibandingkan kelompok plasebo (r -0,206; p0,215).Simpulan. Fluoxetine dosis 20 mg/hari selama 8 minggu pada pasien depresipasca SKA tidak meningkatkan kadar NO. Penurunan skor BDI pasien depresipasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu tidak berkorelasi dengan peningkatan kadar NO.

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ABSTRACTBackground. Depression was prevalent in post acute coronary syndrome (ACS)patients and this condition was related with increasing morbidity and mortality.selective serotonin reuptake inhibitor has established as a treatment choice fordepression in post ACS patients. Nitric oxide (NO) was a well known marker ofendothelial function. Study on SSRI Citalopram showed an increasing level of NOafter administration of citalopram. Fluoxetine was available in Indonesia, but itsfunction in improving endothelial function through the increasing of NO levelremains unknown.Purpose. To evaluate the influence of fluoxetine 20 mg daily for 8 weeks inincreasing NO level in patients post ACS with depression, and to evaluate thecorrelation between improvement in depressive symptoms and increment of NOlevel in post ACS depression patients who receive fluoxetine 20 mg daily for 8weeks.Method. It was a randomized double blind clinical trial counducted in JanuarySeptember2015 whic held in Sardjito General Hospital Yogyakarta. Eligiblesubjects were post ACS age 40-60 years who fulfilled depression criteria. Subjectswere randomized to receive fluoxetine 20 mg daily or plasebo for 8 weeks. Depressive symtoms were evaluate using BDI inventory. Nitric oxide level weretaken at baseline and the end of week 8.Results. From 44 subjects, 24 subjects received fluoxetine, while 20 subjectcsreceived placebo. Analysis was done in 19 subjects of fluoxetine group and 19subjects of plasebo group. Means of NO level before and after treatment influoxetine group were 31,86(2,4) μm and 29,7(2,7) μm respectively. We found nocorrelation between improvement of depressive symptoms and increment of NOlevel (r -0,206; p 0,215).Conclusions. The NO level was not increased in post ACS depression patientswho recieve fluoxetine 20 mg daily for 8 weeks. The improvement of depressivesymptoms was not correlated with increment of NO level in post ACS patients depression patients who recieve fluoxetine 20 mg daily for 8 weeks."

"Diabetes mellitus (DM) is one of the public health problems worldwide, including in Indonesia. Cardiovascular disease was the main cause of death (75-80%) in DM, three-fourths of this death was caused by coronary heart disease (CHD). Approximately 34.2% of patients with acute coronary syndrome (ACS) receiving care at ICCU of Dr. Cipto Mangunkusumo General Hospital (RSCM) suffered from DM. Mortality rates of ACS in DM patients were still high and ACS prognosis in DM patients were still unfavorable. There are many factors playing a part in atherosclerosis and ACS incidence in DM patients, such as metabolic disorders due to hyperglycemia and the fomration of advanced glycation end product (AGE), oxidative stress, atherogenic dyslipidemia in DM in the form of high triglyceride level and low HDL cholesterol as well as an increase in small dense LDL, and insulin resistance. In addition, other risk factors of CHD frequently encountered with DM were hypertension, obesity, thrombocytc hyperaggregation and hypercoagulation. The management ofthis disease which was based on the control of risk factors was not yet satisfactory.Inflammatory response played an important role in pathogenesis of atherosclerosis, beginning with early lesion up to acute coronary syndrome. Increase in inflammatory responses (hsCRP) could predict cardiovascular event and predict post-ACS prognosis. Studies in DM population showed an increase in inflammation. ln-depth studies on inflammatory responses in ACS DM patients have not yet been reported. In normal condition, there was a balance of proinflammatory and antiinflammatory cytokines. The ratio of proinflammatory and antiinflammatory cytokines in ACS, particularly DM patients has not been studied. The relationship between metabolic factor (blood glucose, glyco Hb and lipid) and inflammatory response in ACS DM patients has not yet also been studied.Currently, the effort to decrease inflammatory response is made, among others, by aspirin, statin hypolipidemic medication and insulin sensitizer. Although aspirin and statin were used routinely in ACS patients and have proved to reduce inflammation, morbidity and mortality rates of ACS patients were still high. Thus, we would like to observe whether an addition of other medications in standard therapy could reduce inflammation better. Curcumin in experimental animals-and humans) showed -hypolipidemic effect (decrease 'in absorption and increase in catabolism) and hypoglycemia (effect on PPAR-7). Curcumin also demonstrated antiinflammatory effect. In this study we would like to observe the effects of curcumin on both metabolic factors and inflammatory responses in ACS patients.PROBLEM IDENTIFICATIONThe above elaboration showed a discrepancy associated with inflammatory response in DM ACS patients. Up to now, the relationship of metabolic factor and inflammatory response in DM ACS has not been clear yet. Likewise, the effects of curcumin on metabolic factor and inflammatory response in ACS have not yet been identified.OBJECTIVESTo evaluate inflammatory responses in DM ACS and its relationship with metabolic factors (glucose, blood; glyco Hb, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride); to evaluate the ratio of proinflammatory and antiinflammatory cytokines (IL-6/IL-10) in ACS DM patients, and to identify the effects of curcumin on metabolic factors and inflammatory responses in ACS patients.SETTINGThe study was conducted at ICCU of RSCM, ICCU of Persahabatan, ICCU of RS MMC and ICCU of Medistra Hospital, Cardiology Polyclinic, Department of Internal Medicine, Faculty of Medicine University of Indonesia! RSCM and Integrated Cardiac Service Poiyclinic of RSCM.STUDY SUBJECTSACS patients (DM and non-DM) and CHD (DM and non-DM).DESIGNThere were two studies: l. Observational design to observe inflammatory responses (hscRP, IL-6, IL-IO, VCAM and ICAM) in DM ACS, non-DM ACS, DM CI-ID, and non-DM CHD; to evaluate the relationship between metabolic factors (fasting blood glucose, blood glucose 2 hours PP, glyco Hb, total cholesterol, LDL cholesterol, HDI.. cholesterol and triglyceride) and inflammatory responses (hsCRP, IL-6, IL-10, VCAM and ICAM) in ACS DM. 2. Interventional study which was a double-blind randomized trial to evaluate the effects of curcumin at escalating doses (low dose 3:-:IS mglday, moderate dose 3x30 mg/day and high dose 3x60 mg/day on metabolic factors (fasting blood glucose. blood glucose 2 hours PP and glyco Hb) and the effects of curcumin at escalating doses on inflammatory responses (hsCRP, ll.-6, VCAM and ICAM) in ACS patients.RESULTSIn observational study, |46 subjects were analyzed, consisting of 84 ACS patients, (30 DM ACS patients and 54 non-DM ACS), and 62 CHD (25 DM CHD patients and 37 non-DM CHD patients). The results of the study in the four groups of patients showed: 1. Inflammatory response in DM ACS was higher than in DM CHD (hsCRP, p=0.00; II..-6, p=0.00; IL-10, p=0.00) and non-DM ACS (ICAM, P=0.03). 2. The ratio of proinflammatory and antiinflammatory cytokines (IL-6/II..-10) in DM ACS did not differ from that of DM CHD (p=0.2l) and non-DM ACS (p=0.5 l). 3. There was a relationship between metabolic factors and inflammatory responses in DM ACS: triglyceride and ll.-6 (r=O.39, p=0.03) and II..-I0 (r=0.37, p=o.o4).In interventional study we performed randomization in 75 ACS patients divided into four groups, consisting of low-dose curcumin group of 15 patients, moderate-dose curcumin group of 15 patients, high-dose curcumin group of IS patients, and placebo group of 30 patients. The results of the study in these four groups showed: l. Low-dose curcumin showed a decrease in hsCRP in one week ofthe first month after intervention, there was a significant difference liom that of placebo (p=0.04). Low-dose, moderate-dose, high-dose curcumin groups showed a decrease in IL-6, but was not significantly different from placebo. Low-dose, moderate-dose, high-dose curcumin did not show a decrease in VCAM and ICAM after intervention of 2 months. 2. Low-dose curcumin group tended to experience a decrease in glyco Hb level after intervention of 2 months (p=0.06); however, it was not significantly different from that of placebo. 3. There was a tendency that low-dose curcumin reduced total cholesterol and LDI. cholesterol; however, it was not significantly different from that of placebo. There was a tendency that low-dose curcumin increased HDL cholesterol; however, it was not significantly different from that of placebo. 4. There was a tendency that the pattern of escalating doses had some effects in inflammatory responses and metabolic factors, in which low-dose curcumin showed the best effects, followed by moderate-dose and finally high- dose curcumin.CONCLUSIONSIn this study, inflammatory responses in DM ACS patients were higher than those in DM CHD and non-DM ACS patients. There was no difference in the ratio of proinflammatory and antiinflammatory cytokines (IL-6fIL-IO) in DM ACS compared with DM CHD and non-DM ACS. ln addition, the present study identified some of the relationships between metabolic factors and inflammatory responses. Low-dose curcumin reduced hsCRP in one week of the first month after the intervention in ACS patients. There was a tendency that low-dose curcumin reduced glyco Hb level in ACS."

"ABSTRAKSindrom Koroner Akut SKA merupakan kondisi kegawatdaruratan akibat ketidakseimbangan antara kebutuhan oksigen miokardium dengan suplai darah yang dapat berakibat pada kematian. Penanganan SKA dengan intervensi koroner perkutan dapat meningkatkan kualitas hidup. Pedoman American Heart Association AHA merekomendasikan standar waktu ? 120 menit dari awal mula munculnya gejala hingga pasien tiba di rumah sakit yaitu. Namun masih ditemukan terjadinya keterlambatan prehospital. Penelitian ini bertujuan untuk mengidentifikasi hubungan representasi gejala dengan keterlambatan prehospital pada pasien sindrom SKA. Desain penelitian menggunakan cross sectional dengan metode purposive sampling yang melibatkan sampel sebanyak 63 responden. Responden didominasi oleh lansia yang berusia 51-60 tahun, laki-laki, tingkat Pendidikan SMA. Hasil penelitian menunjukan ada hubungan antara representasi gejala yang meliputi tingkat nyeri p 0.001, kualitas nyeri p 0.01, dan lokasi nyeri p 0.032 dengan keterlambatan prehospital terkecuali gejala penyerta p 0.054. Perawat dianjurkan meningkatkan kompetensi dalam pengkajian gejala SKA dan pemberian edukasi. Sehingga dapat menurunkan angka keterlambatan prehospital.

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ABSTRACTAcute Coronary Syndrome ACS is an emergency condition due to an imbalance between the need for oxygen and the blood supply that can result in death. ACS with percutaneous coronary intervention may improve the quality of life. The American Heart Association ACCF AHA guidelines recommended is 120 minutes from onset symptoms until hospital arrived. for recording time standards when facing symptoms arrive at the hospital However, there is still a pre hospital delay. This study aimed to identify correlation of symptoms representation with pre hospital delay in patients with ACS symptoms. This crossectional study design is cross sectional of purposive sampling method involved 63 respondents. Respondents mostly 51 60 years old, men, and high school education level. The results showed there was a correlation symptoms factor representation including pain level p 0.001, pain quality p 0,01, and pain location p 0,032 except commorbid symptom p 0,054. Nurses recommended to improve their ability to assess ACS symptoms and provide proper health education to decrease educational the prehospital delays."

"Latar Belakang: Peningkatan serotonin plasma dan kortisol saliva yang terjadi pada sindrom koroner akut juga terjadi pada gejala ansietas. Dan kedua penanda biologis tersebut digunakan untuk mengetahui adanya gejala ansietas. Tujuan: Mengetahui perbedaan rerata serotonin plasma dan kortisol saliva pada sindrom koroner akut dengan gejala ansietas di RSUPN dr. Cipto Mangunkusumo. Metode: Dilakukan penelitian klinis poong lintang. Hasil: Kadar serotonin plasma dengan gejala ansietas dan tanpa gejala ansietas dibandingkan nilai normal yaitu 194,83 (142,00-892,04) ng/mL dan 167,16 (150,40-225,96) ng/ml. Kadar kortisol saliva pada subjek dengan gejala ansietas dan tanpa gejala ansietas adalah 2,75 (1,28-4,91) µg/dL dan 2,69 (0,91-7,09) µg/dL. Simpulan: Ada peningkatan kadar serotonin plasma dan kortisol saliva pada gejala ansietas walaupun tidak terdapat hubungan antara serotonin plasma dan kortisol saliva dengan gejala ansietas pada pasien SKA.

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Background: Increases in plasma serotonin and salivary cortisol that occur in acute coronary syndrome also occur in symptoms of anxiety. And the two biological markers are used to determine the presence of anxiety symptoms.

Objective: To determine the difference in mean plasma serotonin and salivary cortisol in acute coronary syndrome with anxiety symptoms at RSUPN dr. Cipto Mangunkusumo.

Methods: Poong Lintang clinical research was conducted.

Results: Compared to normal values, plasma serotonin levels with anxiety symptoms and without anxiety symptoms ​​were 194.83 (142.00-892.04) ng/mL and 167.16 (150.40-225.96) ng/ml. Salivary cortisol levels in subjects with anxiety symptoms and without anxiety symptoms were 2.75 (1.28-4.91) µg/dL and 2.69 (0.91-7.09) µg/dL.

Conclusion: There is an increase in plasma serotonin and salivary cortisol levels in anxiety symptoms although there is no relationship between plasma serotonin and salivary cortisol with anxiety symptoms in ACS patients."

"[ABSTRAKLatar Belakang: Major adverse cardiac events (MACE) merupakan komplikasi serius pada pasien pasca sindrom koroner akut (SKA) sehingga perlu suatu metode yang andal dalam memprediksi kejadiannya. Heart rate variability (HRV) yang menggambarkan ketidakseimbangan sistem otonom pasca SKA dan dapat dilakukan dengan cara yang lebih cepat, mudah, dan praktis berpotensi dapat digunakan sebagai alat stratifikasi risiko MACE.Tujuan: Mengetahui kemampuan HRV awal perawatan yang diukur melalui metode pulse photoplethysmograph (PPG) dalam memprediksi MACE pada pasien pasca SKA yang dirawat di intensive cardiac care unit (ICCU).Metode: Studi ini adalah studi kohort prospektif dengan subjek pasien SKA yang menjalani perawatan di ICCU. Pemeriksaan HRV dilakukan dengan metode PPG dalam 48 jam pasca diagnosis SKA dan adanya MACE dideteksi selama perawatan di ICCU. Komplikasi yang digolongkan sebagai MACE adalah kematian, aritmia fatal, gagal jantung, syok kardiogenik, re-infark, dan komplikasi mekanik. Kemampuan HRV dalam memprediksi MACE dinyatakan melalui AUC (+IK95%) dan untuk parameter yang memiliki kemampuan prediksi baik akan dihitung nilai prediksi positif (PPV) dan nilai prediksi negatif (NPV) beserta IK95% parameter tersebut.Hasil: Sebanyak 75 subjek SKA menjalani pengukuran HRV < 48 jam pasca diagnosis dan sebanyak 18,7% di antaranya mengalami MACE. Parameter LF dengan AUC 0,697 (0,543-0,850) dan rasio LF/HF dengan AUC 0,851 (0,741-0,962) memiliki kemampuan diskriminasi MACE yang paling baik. Parameter LF pada titik potong 89,673 memiliki PPV dan NPV sebesar 13% dan 71%, sedangkan rasio LF/HF pada titik potong 1,718 sebesar 6% dan 50%.Kesimpulan: Variabel LF dan rasio LF/HF merupakan parameter HRV yang dinilai memiliki kemampuan diskriminasi cukup baik terhadap MACE. Kedua variabel tersebut memiliki nilai prediksi negatif sehingga dapat digunakan untuk menyingkirkan kemungkinan terjadinya MACE pada mereka dengan nilai LF > 89,673 dan rasio LF/HR > 1,718.

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ABSTRACTIntroduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.;Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718., Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.]"

"Latar Belakang : Indonesia memiliki angka kematian karena penyakit kardiovaskular yang semakin meningkat, dengan angka kematian diperkirakan sebanyak 17,3 juta kematian. Mengingat tingkat mortalitas yang sangat tinggi pada pasien dengan sindrom koroner akut SKA, maka diperlukan sebuah prediktor Major Adverse Cardiac Event MACE yang objektif dan terukur untuk manajemen pasien SKA dalam jangka panjang. Pada SKA dapat ditemukan heterogenitas repolarisasi ventrikel yang dapat dilihat pada elektrokardiografi EKG sebagai QTmax-QTmin, atau dapat disebut sebagai QTD.QTD disinyalir dapat dijadikan penanda untuk risiko MACE pada pasien SKA. Tujuan : Mengetahui peran dispersi QT dan QTcD sebagai prediktor MACE pada pasien sindrom koroner akut SKA. Metode : Penelitian ini merupakan studi kohort retrospektif pada 230 rekam medis pasien SKA yang dirawat di ICCU RSCM dalam rentang waktu Januari 2016 hingga November 2017. EKG standar 12 sadapan saat serangan dianalisis dan dilakukan pengukuran interval QTmax dan QTmin yang kemudian dihitung QTd. Selanjutnya dikoreksi dengan frekuensi nadi menggunakan rumus Bazett QTcD. Hasil : Pemanjangan QTD lebih dari 100mdet dapat menjadi prediktor MACE pada pasien dengan SKA OR 1,25 IK95 0,17 ndash; 2,71 . Setelah dikoreksi dengan frekuensi nadi menggunakan rumus Bazett, pemanjangan QTcD juga dapat menjadi prediktor MACE pada pasien SKA 1,89 IK95 0,05 ndash; 67,37. Kesimpulan : Pemanjangan QTD lebih dari 100mdet atau QTcD lebih dari 12,72mdet dapat menjadi prediktor MACE.

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Background: In Indonesia, the number of death due to cardiovascular disease is rapidly rising and it was approximated to have resulted in 17,3 million deaths. Due to this steadily increasing cases, it is necessary to find a predictor for Major Adverse Cardiac Event MACE that is objective and standardized for long term care of patients with acute coronary syndrome ACS. In ACS, one of the underlying mechanisms is the presence of heterogeneity in ventricle repolarization that is seen on ECG machine as QTmax ndash QTmin, or what is identified as QTD. QTD is hypothesized to have role as marker in patients with MACE in ACS.

Aim: Identify the role of QTD and QTcD as MACE predictor in patients with acute coronary syndrome.

Methods: This study is a retrospective cohort with the subject of 230 ACS patients that was hospitalised on RSCM ICCU among January 2016 to November 2017. Data was taken from medical record and 12 lead ECG during attack were taken and analysed manually to calculate QTmax and QTmin and substraction of both into QTD. Followed by correction using the heart rate with Bazett formula QTcD.

Result: QTD prolongation of more than 100ms in patients with ACS may lead to MACE OR 1,25 IK95 0,17 ndash 2,71 . Following correction with Bazett formula, QTcD prolongation is also predictor 1,89 IK95 0,05 ndash 67,37.

Conclusion: QTD prolongation of more than 100ms or QTcD of more than 12.72ms might lead to MACE "

"Latar Belakang. Salah satu penyebab kematian pada sindrom koroner akut adalah terjadinya komplikasi yang dikenal dengan major adverse cardiac event MACE . Terdapat beberapa prediktor terjadinya MACE pada pasien SKA, diantaranya adalah faktor psikologis yaitu depresi dan ansietas. Saat ini, depresi dan ansietas belum mendapat banyak perhatian padahal memiliki peran penting dalam pengobatan SKA dan prognosisnya. Tujuan. Mengetahui hubungan antara depresi dan ansietas dengan major adverse cardiac event dalam 7 hari pada pasien SKA. Metode. Studi dengan desain kohort prospektif untuk meneliti hubungan antara depresi dan ansietas dengan MACE dalam 7 hari pasien SKA, dengan menggunakan kuisioner HADS pada pasien SKA yang menjalani perawatan di ICCU, Rawat Inap Gedung A RSCM pada bulan Januari ndash; Mei 2018. Analisis bivariat dilakukan untuk menghitung risk ratio RR terjadinya MACE dalam 7 hari pada kelompok depresi dan ansietas dengan menggunakan SPSS. Hasil. Didapatkan jumlah subjek yang memenuhi kriteria inklusi sebanyak 114 orang. depresi didapatkan pada 7 subjek, ansietas didapatkan pada 28,95 subjek, dan MACE didapatkan pada 9,6 subjek. Pada kelompok depesi, MACE 7 hari terjadi pada 12,5 subjek. Pada kelompok Ansietas, MACE 7 hari terjadi pada 21,2 subjek. Pada analisis bivariat didapatkan ansietas meningkatkan risiko terjadinya MACE dalam 7 hari pada pasien SKA, dengan risiko relatif RR sebesar 4,2 IK 1,34 ndash; 13,7. Kesimpulan. Proporsi depresi pada pasien SKA di RSCM sebesar 7 dan proporsi ansietas pada pasien SKA di RSCM sebesar 28,95 . Ansietas pada pasien SKA merupakan prediktor independen terjadinya MACE dalam 7 hari dan meningkatkan risiko terjadinya MACE 7 hari.

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Background. One of the causes of death in acute coronary syndrome is the occurrence of a complication known as major adverse cardiac event MACE. There are several predictors of the occurrence of MACE in patients with ACS, including psychological factors such as depression and anxiety. Currently, depression and anxiety have not received much attention when it has an important role in the treatment of ACS and its prognosis.

Objective. To determine the association between depression and anxiety with major adverse cardiac event within 7 days in patients with acute coronary syndrome.

Method. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in January May 2018. Bivariate analysis was performed to calculate the risk ratio RR of MACE occurrence within 7 days in the depression and anxiety group using SPSS.

Results. Obtained number of subjects who meet the inclusion criteria of 114 people. depression was obtained in 7 of subjects, Anxiety was obtained in 28,95 of subjects, and MACE was obtained in 9.6 of subjects. In the depression group, MACE 7 days occurred in 12.5 of subjects. In the Anxiety group, MACE 7 days occurred in 21,2 of subjects. In bivariate analysis, anxiety increased the risk of MACE within 7 days in patients with ACS, with relative risk RR of 4,2 IK 1,34 ndash 13,7.

Conclusion. The proportion of depression in patients with SKA in RSCM was 7 and the proportion of anxiety in ACS patients in RSCM was 28,95. Anxiety in patients with ACS is an independent predictor of MACE within 7 days and increases the risk of a 7 day MACE. "

"Klopidogrel, agen antiplatelet pasca Intervensi Koroner Perkutan (IKP), merupakan obat yang profil farmakokinetik dan farmakodinamiknya dipengaruhi oleh Indeks Massa Tubuh (IMT). Penelitian ini bertujuan untuk mengetahui pengaruh IMT terhadap respon klopidogrel pada pasien Sidrom Koroner Akut (SKA) setelah IKP. Penelitian ini menggunakan desain studi potong lintang terhadap 143 rekam medis pasien SKA dengan IKP di RSUPN Dr. Cipto Mangunkusumo Jakarta pada tahun 2018. Subyek dikelompokkan berdasarkan IMT, yakni kategori berat badan berlebih dan kategori berat badan tidak berlebih. Respon klopidogrel dinilai menggunakan luaran Major Adverse Cardiac Event (MACE) dalam tiga puluh hari pertama. Hasil dari penelitian adalah (a). Secara signifikan subyek dengan berat badan berlebih memiliki risiko terjadi MACE lebih tinggi dibanding subyek dengan berat badan tidak berlebih (PR = 6,792, CI 1(1,498 – 30,805). (b). Tidak ada variabel perancu yang berhubungan dengan MACE kecuali jenis klopidogrel. Subyek dengan klopidogrel generik bersifat proteksi terhadap MACE dibanding subyek dengan klopidogrel paten (Plavix) (PR 0,098, CI 0,013 -0,753). Kesimpulan dari penelitian ini adalah IMT berpengaruh secara signifikan terhadap MACE.

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Clopidogrel, antiplatelet agent after Percutaneous Coronary Interventions (CPI), is  drug with high individual pharmacokinetic and pharmacodynamic variability interfered by Body Mass Index (BMI). The aim of this study is to assess  impact of BMI on clopidogrel responses after PCI. This comparative cross-sectional study was conducted in RSUPN Dr. Cipto Mangunkusumo Jakarta using 143 Acute Coronary Syndrome (ACS) patient health record years of 2018. Patients were randomly assigned into two groups based on BMI, overweight and normal weight groups. Results of this study are: (a). Overweight patient have higher MACE risk than normalweight patient (PR = 6,792, CI 1(1,498 – 30,805). (b) . No confounding variables are associated with MACE, except type of clopidogrel. Generic clopidogrel have protective effect of MACE ((PR 0,098, CI 0,013 -0,753)."

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

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

"Self-care merupakan bagian penting dalam upaya peningkatan kualitas hidup pada pasien sindrom koroner akut yang telah menjalanai intervensi koroner perkutan. Self-care adalah pengambilan keputusan secara natural oleh individu dalam berperilaku untuk mempertahankan kestabilan fisiologis tubuhnya dan sebagai respon terhadap tanda dan gejala yang terjadi pada diri individu. Keadekuatan individu dalam melakukan self-care dapat dipengaruhi oleh berbagai faktor internal maupun eksternal dari individu. Identifikasi faktor tersebut menjadi bagian penting untuk memberikan asuhan keperawatan mengenai self-care yang efektif. Penelitian ini bertujuan untuk mengidentifikasi hubungan dari karakteristik responden: usia, jenis kelamin, pendidikan, pekerjaan, penghasilan, pengetahuan, dukungan keluarga, kecemasan, depresi dan literasi kesehatan pasien sindrom koroner akut yang telah menjalani intervensi koroner perkutan meliputi: usia, jenis kelamin, terhadap self-care. Desain penelitian menggunakan cross sectional survey pada 121 responden yang diambil dengan tehnik consecutive sampling di Poliklinik Jantung. Penelitian menggunakan kuesioner SC-CHDI (self-care coronary heart disease invantory) dalam mengukur self-care responden. Hasil penelitian menunjukan usia (p=0,273), pendidikan (p=0,004), dukungan keluarga (p=0,009), kecemasan (0,015), depresi (p=0,000), pengetahuan (p=0,003) dan literasi kesehatan (p=0,005) berhubungan dengan self-care individu secara signifikan. Responden yang bekerja dan tidak mengalami depresi memiliki self-care yang lebih adekuat

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Self-care is an important part in efforts to improve the quality of life in acute coronary syndrome patients who have undergone percutaneous coronary intervention. Self-care is a natural decision making by individuals in behaving to maintain the physiological stability of their bodies and in response to signs and symptoms that occur in individuals. Individual adequacy in performing self-care can be influenced by various internal and external factors of the individual. Identification of these factors is an important part of providing nursing care regarding effective self-care. This study aims to identify the relationship of respondent characteristics: age, gender, education, occupation, income, knowledge, family support, anxiety, depression and health literacy of acute coronary syndrome patients who have undergone percutaneous coronary intervention including: age, gender, to self-care. The research design used a cross sectional survey on 121 respondents who were taken with consecutive sampling technique at the Cardiac Polyclinic. The study used the SC-CHDI (self-care coronary heart disease invantory) questionnaire in measuring respondents' self-care. The results showed age (p = 0.273), education (p = 0.004), family support (p = 0.009), anxiety (0.015), depression (p = 0.000), knowledge (p = 0.003) and health literacy (p = 0.005 ) was significantly associated with individual self-care. Respondents who work and do not experience depression have more adequate self-care"