Tesis

Efek Pemberian Atorvastatin terhadap Respon Inflamasi pada Pasien Infark Miokardium Akut dengan Elevasi Segmen ST pasca Intervensi Koroner Perkutan Primer = Effect of Atorvastatin on Inflammatory Response in Patients with ST Segment Elevation Myocardial Infarction Post Primary Percutaneous Intervention

Latar belakang. Nekrosis miokardium menginduksi reaksi inflamasi yang hebat
dan penempelan netrofil melalui Intercellular Adhesion Molecule (ICAM). Hasil
studi ARMYDA-CAMS menunjukkan bahwa pemberian Atorvastatin secara
kontinyu pra-Intervensi Koroner Perkutan (IKP) dapat menurunkan kadar ICAM
pasca-tindakan pada pasien dengan Angina Pektoris Stabil (APS). Hingga saat ini
belum ada penelitian yang melihat efek akut pemberian Atorvastatin 80 mg pada
pasien Infark Miokardum Akut dengan Elevasi Segmen ST (IMA-ST) yang
menjalani Intervensi Koroner Perkutan Primer (IKPP).
Metode. Penelitian ini merupakan suatu uji klinis acak tersamar ganda. Evaluasi
dilakukan pada 76 pasien IMA-ST yang menjalani IKPP di Pusat Jantung
Nasional Harapan Kita dari bulan Februari hingga bulan Agustus 2014. Pasien
dibagi secara acak tersamar ganda menjadi dua kelompok (Atorvastatin 80 mg dan
Plasebo). Pemeriksaan ICAM diambil dua kali (0 dan 24 jam pasca-IKPP).
Dilakukan analisis statistik untuk menilai efek pemberian Atorvastatin yang
dinilai dengan delta ICAM.
Hasil. Tidak terdapat perbedaan bermakna pada data dasar kedua kelompok dalam
hal klinis, pemeriksaan penunjang, dan angiografik. Nilai delta ICAM
menunjukkan perbedaan yang signifikan, yaitu pada kelompok Atorvastatin 80
mg (-13,0±38,5 ng/mL) dan Plasebo (26,1±67,0 ng/mL, p 0,003). Analisa regresi
linear (adjusted analysis; sesuai usia, jenis kelamin, diabetes, dan insufisiensi
renal) menunjukkan koefisiensi -31,17 ng/mL dengan p 0,037.
Kesimpulan. Pemberian Atorvastatin 80 mg secara akut pada pasien IMA-ST
menurunkan respon inflamasi endotelium yang dinilai dengan kadar ICAM.
Kata kunci: IMA-ST, IKPP, inflamasi, Atorvastatin, ICAM


Background. Myocardial necrosis triggers complement activation and neutrophyl
adhesion which is mediated by Intercellular Adhesion Molecule (ICAM). Results
from ARMYDA-CAMS, showed that Atorvastatin continuous treatment reduced
ICAM value in patients with stable angina pectoris. To date, there are no study yet
which investigates the effect of acute Atorvastatin 80 mg treatment in patients
with ST Segment Elevation Myocardial Infarction (STEMI) post Primary
Percutaneous Coronary Intervention (PPCI).
Methods. This is a randomized, double-blinded, controlled trial. Evaluations were
performed on 76 STEMI patients who underwent PPCI at National Cardiac Center
Harapan Kita (NCCHK) from February 2014 to August 2014. Patients were
randomly classified into two groups (Atorvastatin 80 mg and Placebo).
Laboratory data on ICAM were taken twice (0-hour and 24-hour post PPCI) and
examined at Prodia’s Laboratorium. Statistical analyses using SPSS were
performed to evaluate the effect of Atorvastatin treatment, which was measured
by delta ICAM.
Results. There were no difference between two groups (Atorvastatin vs. Placebo)
in terms of clinical, supporting data, and angiographic findings. Delta ICAM
values showed significant difference between two groups, which are Atorvastatin
80 mg (-13,0±38,5 ng/mL) and Plasebo (26,1±67,0 ng/mL, p 0,003). Linear
regression analysis (adjusted analysis; according to age, sex, diabetes, and renal
insufficiency) showed coefficient of -31,17 ng/mL with p 0,037.
Conclusion. This study showed that acute Atorvastatin 80 mg treatment pre-PPCI
reduces endothelial inflammatory response which was measured by ICAM.
Keywords: STEMI, PPCI, inflammation, Atorvastatin, ICAM