Latar Belakang:Banyak penelitian telah membuktikan pengaruh faktor inflamasi terhadap sindroma koroner akut.Tingginya jumlah leukosit pasca intervensi koroner perkutan primer (IKPP) menggambarkan respon inflamasi pada patofisiologi infark miokard akut dengan elevasi segmen ST (IMA – EST)dan respon terhadap kerusakan dinding arteri.Hal ini dihubungkan dengan luaran klinis yang buruk.Tujuan penelitian ini adalah untuk menilai pengaruh jumlah leukosit pasca IKPP terhadap perbaikan fungsi jantung kiri menggunakan indeks gerakan otot jantung segmental (RWMI) pada area terkait infark.Metode:Sebanyak 62 subjek IMA–EST yang menjalani IKPP secara konsekutif dipilih dan diikuti selama 30 hari, sejak 1 Januari–30 April 2013. Jumlah hitung leukosit diukur pada saat masuk dan 48 jam pasca IKPP, derajat sebukan miokard (MBG), aliran TIMI dan RWMI diukur segera setelah IKPP. RWMI dievaluasi menggunakan ekokardiografi setelah 30 hari pasca infark, dengan menilai kesepahaman intra dan inter observer. Perhitungan statistik dinilai dengan software stata versi 12.Hasil: Pasien dengan jumlah leukosit 48 jam pasca IKPP > 12,020/uL memiliki OR: 4,4 (95% CI: 0,98 – 19,85; p = 0,05) untuk mengalami irreversibilitas gerakan otot jantung segmental terkait infark pada 30 hari, analisa multivariat menunjukan leukosit pasca IKPP secara konsisten memprediksi irreversibilitas RWMI dengan OR 5,6 (95% CI: 1,08 – 28,6; p = 0,039).Kesimpulan: Jumlah leukosit pasca IKPP diatas quartile ke-3 dengan lebih dari 12,020/uL pada jam ke-48 dapat meningkatkan risiko irreversibilitas gerakan otot jantung segmental ventrikel kiri, pada area terkait infark pasien IMA-EST.
Background: Many researches has proven inflammation response in the pathophysiology of acute coronary syndrome (ACS) with ST segment elevation (STEMI). High leukocyte count post primary percutaneous intervention (PPCI) describes the magnitude of inflammatory state in ACS and inflammatory respond to arterial injury, and associated with poor prognosis. The aim of this study was to see the correlation between leucocytes post PPCI with improvement of left ventricle function measure by regional wall motion index (RWMI).Method: 62 STEMI subjectswhom underwent PPCI were selected consecutively between 1st Jan – 30th Apr 2013, and followed up for 30 days. Total leukocyte count was measure during admission and 48 hours post PPCI. TIMI flow and myocardial blush grade were measure immediately post procedural. RWMI was measure soon after PPCI and at 30 days, intra and inter observer variability were analyzed. Logistic regression was used to correlate variable independent and dependent, using software Stata version 12.Result: Patients with 48 hours leukocyte count >12,020/uL post PPCI, has OR 4,4 (95% CI: 0,98 – 19,85; p = 0,05), to predict irreversibility in regional systolic wall motion related to infarct teritory,measure at 30 days.Multivariate analysis consistently shown leukocyte post PPCI as strong predictor of RWMI irreversibility, with OR 5,6 (95% CI: 1,08 – 28,6; p = 0,039).Conclusion: High total leukocyte count post PPCI above 3rd quartile, > 12,020/uL taken at 48 hours,increase the risk of regional wall motion irreversibility in infarct related area. |
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