Tesis

Hubungan Red Distribution Width to Platelet Ratio dengan Beban Trombus Intrakoroner pada Pasien Infark Miokard Akut dengan Elevasi Segmen ST yang Menjalani Intervensi Koroner Perkutan Primer = The Association between Red Distribution Width to Platelet Ratio with Intracoronary Thrombus Burden in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Latar belakang: Red distribution width (RDW) to platelet ratio (RPR) telah terbukti berhubungan dengan mortalitas dan no-reflow pada infark miokard akut dengan elevasi segmen ST (IMA-EST) namun mekanismenya belum jelas. Pada pembentukan trombus, RDW tinggi mempengaruhi agregasi eritrosit dan jumlah trombosit rendah karena pemakaian dan destruksi yang tidak diimbangi laju produksi. Tujuan: Mengetahui hubungan antara nilai RPR admisi dan beban trombus intrakoroner pada IMA-EST. Metode: Terdapat 527 pasien IMA-EST yang menjalani intervensi koroner perkutan primer (IKPP) pada periode Juli 2018 hingga Juli 2020 dianalisis secara retrospektif. Beban trombus intrakoroner menurut TIMI saat IKPP dibagi menjadi beban trombus tinggi (BTT) dan beban trombus rendah (BTR). Titik potong RPR admisi ditentukan untuk menentukan hubungan dengan BTT. Hasil: Beban trombus intrakoroner tinggi berdasarkan TIMI didapatkan pada 36,8% pasien. Pasien dengan RPR admisi > 0,0495 lebih sering menunjukkan BTT saat IKPP (43,6% vs 31,7%; OR 1,57 95%IK:1,08-2,30; p=0,019). Prediktor beban trombus tinggi yang diperoleh dari analisa regresi logistik multivariat adalah: infark pada RCA (OR 3,02; 95%IK: 2,05-4,46; p < 0,001), waktu iskemik > 360 menit (OR 2,26; 95%IK: 1,33-3,83; p=0,003) dan usia > 65 tahun (OR 1,95; 95%IK 1,12-3,40; p=0,018). Kesimpulan: Nilai RPR admisi berhubungan dengan kondisi beban trombus intrakoroner pada IMA-EST.
Kata Kunci: IKP primer; IMA-EST; red distribution width; trombus; trombosit


Background: Red distribution width (RDW) to platelet ratio (RPR) is associated with mortality and no-reflow in acute ST-elevation myocardial infarction (STEMI), however the mechanism is unclear. In thrombus formation, high RDW is related to erythrocyte aggregation and low platelet count is thought due to consumption and destruction that is not compensated by production rate. Objective: This study aimed to determine association between admission RPR and other factors related to intracoronary thombus burden in STEMI. Methods: A total of 527 patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) between July 2018 and July 2020 were retrospectively analyzed. Intracoronary thrombus burden based on TIMI criteria was reclassified into high thrombus burden (HTB) and low thrombus burden (LTB). RPR cut-off value was determined for further analysis with HTB. Results: High intracoronary thrombus burden was found in 36,8% patients. Patients with RPR admision > 0,0495 tend to showed HTB during PPCI (43,6% vs 31,7%; OR 1,57 95% CI:1,08-2,30; p=0,019). Other predictors of high thrombus burden from multivariate logistic regression were RCA as infarct-related artery (OR 3,02; 95% CI 2,05-4,46; p < 0,001), ischemic time > 360 minutes (OR 2,26; 95% CI: 1,333,83; p=0,003) and age > 65 years old (OR 1,95; 95%CI: 1,12-3,40; p=0,018). Conclusion: Admission RPR value is associated with intracoronary thrombus burden in STEMI during PPCI.
Keywords: platelet; primary PCI; red distribution width; STEMI; thrombus burden