Tesis

Hubungan Antara Konsentrasi Proprotein Convertase Subtilisin Kexin Type-9 Plasma dengan Luaran Kardioserebrovaskular Mayor pada Pasien Infark Miokard Akut Disertai Elevasi Segmen ST yang Menjalani Intervensi Koroner Perkutan Primer = Association Between Plasma Proprotein Convertase Subtilisin Kexin Type-9 Level And Major Cardiocerebrovascular Outcome In Acute ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Latar belakang: PCSK9 telah diketahui sebagai molekul yang berperan dalam regulasi kadar kolesterol LDL darah. Belakangan ini, PCSK9 diketahui memiliki mekanisme kerja lain yang melibatkan proses inflamasi, peningkatan Lp(a), aktivasi jaras protrombotik dan platelet, metabolisme triglyceride-rich lipoprotein, serta modifikasi plak yang juga dapat berperan dalam patogenesis berbagai spektrum penyakit aterosklerotik, termasuk IMA-EST. Kemajuan dalam strategi penatalaksanaan IMA-EST telah berhasil meningkatkan kesintasan, akan tetapi sekelompok pasien masih mengalami luaran klinis buruk meski telah mendapatkan tatalaksana optimal. PCSK9 dipikirkan dapat memiliki peranan dalam risiko residual pasien-pasien tersebut.
Tujuan: Penelitian ini bertujuan untuk mempelajari hubungan antara konsentrasi PCSK9 saat admisi pada pasien IMA-EST yang menjalani IKPP dengan luaran kardioserebrovaskular mayor.
Metode: Sebanyak 239 pasien dengan IMA-EST yang menjalani IKPP diperiksakan konsentrasi PCSK9 pada saat admisi. Pengukuran konsentrasi plasma PCSK9 didapatkan dengan menggunakan metode ELISA. Data luaran kardioserebrovaskular mayor dan data penunjang lain didapatkan dari rekam medik dan follow-up telepon.
Hasil: Terdapat 28 (11,7%) subjek penelitian yang mengalami luaran kardioserebrovaskular mayor dalam 30 hari. Akan tetapi, analisis kesintasan tidak menunjukkan adanya hubungan yang bermakna secara statistik antara konsentrasi plasma PCSK9 dengan luaran kardioserebrovaskular mayor dalam 30 hari. Saat dibandingkan antara tertil 3 dengan tertil 2 konsentrasi PCSK9 didapatkan hazard ratio 1,466 (95%IK 0,579-3,714) serta antara tertil 1 dengan tertil 2 didapatkan hazard ratio 1,257 (0,496-3,185).
Kesimpulan: Pada pasien IMA-EST yang menjalani IKPP, tidak terdapat hubungan yang bermakna antara konsentrasi plasma PCSK9 saat admisi dengan luaran kardioserebrovaskular mayor dalam 30 hari.
Kata Kunci: PCSK9, IMA-EST, IKPP, Luaran kardioserebrovaskular mayor


Background: PCSK9 is a molecule that regulates blood LDL cholesterol level. Recent evidences suggest that PCSK9 may also have other mechanisms, such as inflammation, increased Lp(a), triglyceride-rich lipoprotein metabolism, activation of prothrombotic pathways and platelets, and modification of atherosclerotic plaque, which all may play a role in the pathogenesis of atherosclerotic diseases, including STEMI. Previous advances in the management of STEMI had succeed in increasing survival. However, some STEMI patients still experienced adverse outcomes eventhough they already received optimal management in accordance with the guidelines. PCSK9 may have a role in the residual risk that those patients have. However, our knowledge regarding this association between plasma PCSK9 level and MACCE in STEMI is still limited.
Objective: The aim of this study is to evaluate the association between plasma PCSK9 level during admission with MACCE in STEMI patients who underwent primary PCI. Methods: In total, 239 patients with STEMI who were treated with primary PCI had their plasma sample drawn during admission and evaluated for PCSK9 level. PCSK9 level was measured with ELISA. MACCE and other supportive data were taken from the medical records and telephone follow-up.
Results: There were 28 study participants who experienced MACCE in 30 days. However, survival analysis did not show a significant association between plasma PCSK9 level and MACCE in 30 days. The hazard ratio for MACCE between the third tertile and the second tertile of plasma PCSK9 level was 1.466 (95%CI 0.5793.714) and between the first tertile and the second tertile was 1.257 (95%CI 0.4963.185).
Conclusion: There was no significant association between plasma PCSK9 level during admission and 30 days MACCE in STEMI patients treated with primary PCI.
Keywords: PCSK9, STEMI, PPCI, MACCE