Disertasi

Model prediksi diagnostik sindrom koroner akut pada subjek angina pektoris tidak stabil / infark miokard akut-non elevasi segment st risiko rendah. = Diagnostic prediction models of ACS in low risk UAP/NSTEMI subject.

Latar belakang. Angina Pektoris Tidak Stabil (APTS)/Infark Miokard Akut Non Elevasi Segmen ST (IMA-NEST) risiko TIMI rendah tetap memiliki risiko Kejadian Kardiovaskular Utama (KKU) sekitar 9,1 %. Pemeriksaan non-invasif vaskular dan faktor risiko kardiovaskular telah digunakan untuk memprediksi PJK pada subset APTS/lMA- NEST dengan risiko TIMI sedang atau tinggi, namun belum ada data pada pasien dengan risiko rendah. Tujuan penelitian ini adalah untuk mengetahui kemampuan pemeriksaan non-invasif dan faktor risiko kardiovaskular dalam memprediksi adanya dan keparahan PJK pada subjek APTS/IMA-NEST risiko rendah serta mengetahui model prediksi diagnostiknya. Metode: Penelitian ini adalah studi potong lintang untuk menilai hubungan antara pemeriksaan non-invasif dan faktor risiko kardiovaskular dalam memprediksi PJK berdasarkan angiografi untuk menilai tingkat validitas pemeriksaan non-invasif dan faktor risiko kardiovaskular dalam memprediksi PJK. Hasil: Selama 1 (satu) tahun terdapat 1827 subjek dengan APTS/IMA-NEST yang dirawat di RSJPDHK. Seratus empat di antaranya memenuhi kriteria inklusi dan dirnasukkan ke dalam penelitian ini, dengan usia rerata 52,3(6,8) tahun, terdiri dari 60 pria dan 44 wanita. Terdapat 44 subjek PJK, serta 60 subjek dengan koroner normal. Pemeriksaan NO memiliki hubungan paling kuat dengan PJK, p = 0,006 (RR 1,97; IK 95 % 1,17-3,31). Ada dua model prediksi diagnostik yang dikembangkan dengan sistem skoringnya masing-masing. Model utama dengan AUC 74,5 % (IK 95 %: 64,9-84,1), sensitivitas 72,7 % (IK 95 %: 57,2-85,0), spesifisitas 65,0 % (IK 95 %: 51,6-76,9), model altematif memiliki AUC 69,0 % (IK 95 %: 58,9-79,1), sensitivitas 65,9 % elK 95%: 50,1-79,5), spesifisitas 56,7 % elK 95 %: 43,2-69,4). Basil validasi sistem skoring menunjukkan AUC 80 %, sensitivitas 68 % dan spesifisitas 76 %. Terdapat hubungan CIMT dan keparahan PJK yang dinyatakan dalam skor Gensini. Simpulan: Pemeriksaan NO, CIMT, riwayat merokok dan usia gender memiliki nilai validitas diagnostik PJK dan juga merupakan determinan model prediksi PJK, dengan AUC 74,5 %, sensitivitas 72,7 % dan spesifisitas 65 %. Terdapat hubungan antara CIMT dengan keparahan PJK.
Kata kunci: APTS/lMA-NEST, faktor risiko kardiovaskular, pemeriksaan non-invasif, prediksi, sistem skoring.



Background: Major Adverse Cardiovascular Events (MACE) is still persist around 9.1 % even in Low Risk Unstable Angina Pectoris (UAP)lNon-ST Elevation Myocardial Infarction (NSTEMI).There are a lot of study regarding non-invasive examinations and cardiovascular risk factors which might be used to predict CAD in a subset of moderate and high risk patients of UAPINSTEMI, but not in low risk patients. The aim of this study is to determine predictive value of non-invasive examinations and cardiovascular risk factors to predict CAD in low risk UAPINSTEMI and to develop prediction model and scoring system in these subset of patients. Methods:This is a cross-sectional study to determine relationship among non-invasive examinations and cardiovascular risk factors to predict CAD which is demonstrated by coronary angiography and to determine validity of non-invasive examinations and cardiovascular risk factors to predict CAD based on coronary angiography findings. Results: During one year there were 1827 UAPINSTEMI patients admitted to our center. One hundred and four patients fulfilled the inclusion criteria. There were 60 male and 44 female patients with average age 52.3 (6.8) years. Based on angiography, 44 patient had CAD and 60 patient with normal coronary. NO has a significant correlation with CAD, p = 0.006 (RR 1.97; 95 % Cl 1.17-3.31). There were two prediction models developed with its scoring systems. The main model with AUC 74.5 % (95 % Cl: 64.9- 84.1), sensitivity 72.7 % (95 % Cl: 57.2-85.0), specificity 65.0 % (95 % Cl: 51.6-76.9). Meanwhile, the alternative model with AUC 69.0 % (95 % Cl: 58.9-79.1), sensitivity 65.9 % (95 % Cl: 50.1-79.5), specificity 56.7 % (95 % Cl: 43.2-69.4). These scoring systems have been validated and revealed AUC 0.800 (95 % Cl 0.679-0.921) sensitivity 68 % and specificity 76 %. Correlation test between CIMT and severity of CAD revealed r = 0.22 and p = 0.006. Conclusion: CIMT, NO, age-gender and smoking had a diagnostic validity value and were considered as determinant prediction models of CAD, with AUC 74.5 %, sensitivity 72.7 % and specificity 65 %. There were two scoring systems developed and have been validated with acceptable result. There is a relationship between CIMT and severity of CAD.
Key words: cardiovascular risk factors, non-invasive examinations, prediction, scoring systems, UAP/NSTEMI.