Tesis

Faktor-faktor yang menjadi prediktor terjadinya major adverse cardiac events tujuh hari pada penderita sindrom koroner akut yang dilakukan intervensi koroner perkutan di RSUPN Cipto Mangunkusumo Jakarta = Predictors factors of seven-day major adverse cardiac events on acute coronary syndrome patients underwent percutaneous coronary intervention at RSUPN Cipto Mangunkusumo Jakarta.

Latar belakang: Major adverse cardiac events (MACE) merupakan masalah yang besar yang meningkatkan morbiditas dan mortalitas pada penderita sindrom koroner akut. Belum banyak data MACE pada penderita sindrom koroner akut (SKA) pasca intervensi koroner perkutan (IKP). Tujuan penelitian: mengetahui faktor faktor yang menjadi prediktor MACE 7 hari penderita SKA yang dilakukan IKP Metode: Untuk mengetahui faktor-faktor yang menjadi prediktor terjadinya major adverse cardiac events pada penderita sindrom koroner akut yang dilakukan intervensi koroner perkutan dilakukan dengan metode kasus kontrol tanpa penyetaraan. Penelitian melibatkan 461 pasien SKA yang dirawat di unit perawatan intensif jantung RSCM dari tanggal 1 Januari 2015 sampai 30 November 2017. Umur, jenis kelamin wanita, diabetes melitus, hipertensi, gagal jantung, gangguan fungsi ginjal, renjatan kardiogenik, fraksi ejeksi ≤ 40%, stenosis di left main, aritmia, stenosis 3 arteri koronaria, stenosis di left anterior descending artery (LAD) dan stenosis di left main (LM) dilakukan penelitian prediktor terjadinya MACE. Hasil: Renjatan kardiogenik OR=10,65 (p=0,001), stenosis LAD OR=15,23 (p=0,02), fraksi ejeksi ≤ 40% OR=10,8 (p=0,00), faktor stenosis 3 arteri koroner atau lebih OR= 3,47 (p=0,01), gagal jantung OR=3,1 (p=0,02) dan gangguan fungsi ginjal OR=4,76 (p=0,00) terbukti sebagai prediktor terjadinya MACE 7 hari pada penderita SKA yang dilakukan IKP. Faktor jenis kelamin wanita, renjatan kardiogenik, stenosis LAD dan fraksi ejeksi ≤ 40% secara independen berhubungan dengam kejadian MACE pada pasien SKA yang dilakukan IKP, secara berturut-turut (OR 95% CI) 6.33 (1.32-30.50), 17.56 (1.85-167.06), 26.61 (1,38-513,81), dan 7.6 (1.86-31.09). Kesimpulan: Renjatan kardiogenik, stenosis LAD, fraksi ejeksi ≤ 40%, faktor stenosis 3 arteri koroner atau lebih, gagal jantung dan gangguan fungsi ginjal merupakan prediktor terjadinya MACE 7 hari penderita SKA pasca IKP. Renjatan kardiogenik, stenosis LAD, wanita dan fraksi ejeksi ≤ 40% merupakan prediktor independen terjadinya MACE 7 hari penderita SKA pasca IKP.
Kata kunci: MACE, ACS, intervensi koroner perkutan, prediktor


Introduction: Major Adverse Cardiac Events (MACE) are a big problem increasing morbidity and mortality to acute coronary syndrome patients. There is not much MACE data of acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). Therefore, the researcher investigated predictors factors of major adverse cardiac events. Objective: To investigate the predictors factors of seven-day MACE on ACS patients underwent PCI. Method: To investigate the predictors factors of seven-day MACE on ACS patients underwent PCI, unmatched case control was conducted. The research involved 461 ACS patients who were hospitalized in intensive coronary care unit (ICCU) RSCM from 1 January 2015 to 30 November 2017. Age, female gender, diabetes mellitus, hypertension, heart failure, renal dysfunction, cardiogenic shock, ejection fraction ≤ 40%, left main (LM) disease, arrhythmia, 3 vessel diseases, and left anterior descending artery (LAD) stenosis were investigate as the predictors of MACE. Results: Cardiogenic shock OR=10.65 (p=0.001), LAD stenosis OR=15.23 (p=0.02), ejection fraction ≤ 40% OR=10.8 (p = 0.00), 3 vessel diseases OR = 3.47 (p=0.01), heart failure OR=3.1 (p=0.02) and renal dysfunction OR=4.76 (p=0.00) had been as the predictors of seven-day MACE on ACS patients underwent PCI. Factors of female gender, cardiogenic shock, LAD stenosis and ejection fraction ≤ 40% were independently predictors of seven-day MACE on ACS patients underwent PCI; (OR 95% CI) 6.33 (1.32-30.50), 17.56 (1.85- 167.06), 26.61 (1.38-513.81), and 7.6 (1.86-31.09) respectively. Conclusions: Cardiogenic shock, LAD stenosis, ejection fraction ≤ 40%, 3 vessel diseases or more, heart failure and renal dysfunction were the predictors of sevenday MACE on ACS patients underwent PCI. Cardiogenic shock, LAD stenosis, female gender and ejection fraction ≤ 40% were independent predictors of sevenday MACE on ACS patients underwent PCI. The other factors were not significant.
Keywords: MACE, ACS, percutaneous coronary intervention, predictors