Tesis

Hubungan antara Konsentrasi Hemoglobin saat Admisi dengan Kejadian Fenomena No-reflow dan Mortalitas Intra Perawatan pada pasien Infark Miokard Akut disertai Elevasi Segmen ST yang menjalani Intervensi Koroner Perkutan Primer = Relationship between Hemoglobin Concentration at admission with the Incidence of No-reflow Phenomenon and In-Hospital Mortality in Acute Myocardial Infarction with Elevation of ST Segments who underwent Primary Percutaneous Coronary Intervention.

Latar belakang: Anemia pada infark miokard akut disertai elevasi segmen ST (IMA-EST) dihubungkan dengan keadaan pro-koagulan yang merupakan salah satu faktor risiko untuk terjadinya keadaan no-reflow yang akan meningkatnya mortalitas pasca intervensi koroner perkutan primer (IKPP). Namun data dari studi klinis masih bertentangan. Tujuan: Mengetahui hubungan antara konsentrasi hemoglobin (Hb) saat admisi dengan kejadian no-reflow dan mortalitas intra perawatan pasien IMA-EST yang menjalani IKPP. Metode: Studi cross-sectional dilakukan pada database Jakarta Acute Coronary Syndrome Registry yang meliputi 3071 pasien IMA-EST yang menjalani IKPP periode Januari 2014 hingga Desember 2019. Kejadian no-reflow didefinisikan sebagai aliran akhir TIMI < 3 pada infarct-related artery pasca IKPP. Luaran klinis berupa kejadian no-reflow dan mortalitas intra perawatan. Kriteria anemia menggunakan klasifikasi World Health Organization (Pria: Hb < 13 mg/dl; Wanita: Hb < 12 mg/dl). Hasil: Anemia dijumpai pada 550 pasien (17,9%). Dibandingkan dengan grup tidak anemia (N = 2521), pasien pada grup anemia cenderung memiliki usia yang lebih tua (60 + 10 tahun vs. 54 + 10 tahun, p < 0.001), lebih banyak berjenis kelamin wanita (20.7% vs. 11,2%, p < 0.001), dan skor risiko TIMI > 4 (45,8% vs. 30.4%, p < 0.001). Anemia saat admisi tidak berhubungan dengan kejadian noreflow pasca IKPP [odds ratio (OR)= 0,889; interval kepercayaan (IK) 95%, 0.654 - 1.209, p =0,455]. Pada analisis logistik regresi multivariat, anemia tidak berhubungan dengan mortalitas intra perawatan (OR= 0.963; IK 95%, 0.635 - 1.459, p =0.857), begitu juga dengan pasien anemia yang disertai no-reflow (OR= 0.939; IK 95%, 0.361 - 2.437, p =0.896). Kesimpulan: Anemia saat admisi tidak berhubungan dengan kejadian no-reflow dan mortalitas intra perawatan pasien IMA-EST yang menjalani IKPP.
Kata Kunci: IMA-EST; IKP primer; Anemia; No-reflow; Mortalitas intra perawatan


Background: Anemia in acute ST-segment elevation myocardial infarction (STEMI) is associated with a pro-coagulant state, contributing to the incidence of no-reflow phenomenons and increased mortality following primary percutaneous coronary procedure (PPCI). However, clinical data remain contradictory. Objective: To evaluate the association of admission hemoglobin (Hb) concentration and in-hospital mortality of STEMI patients treated with PPCI, as well as final thrombolysis in myocardial infarction (TIMI) flow. Methods: A cross sectional study was performed from the database of Jakarta Acute Coronary Syndrome registry, consists of 3071 STEMI patients who underwent PPCI between January 2014 to December 2019. No-reflow phenomenon was defined as final TIMI flow < 3 of the infarct-related artery. Outcome measures were the occurence of no reflow and in-hospital mortality. Anemia criteria was based on the World Health Organization (Men: Hb < 13 g/dl; Women: Hb < 12 g/dl). Results: Anemia was found in 550 patients (17.9%). Compared with non-anemia, patients with anemia were older (60 + 10 years vs. 54 + 10 years, p < 0.001), more proportion of women (20.7% vs. 11,2%, p < 0.001), TIMI risk score > 4 (45,8% vs. 30.4%, p < 0.00), and killip classification > 1 (25,8% vs. 20.8%, p < 0,009). Anemia at admission was not associated with no-reflow phenomenon [odds ratio (OR)= 0,889; 95% confidence interval (CI), 0.654 - 1.209, p =0,455]. Multivariate regression models showed that anemia was not associated with in-hospital mortality (OR= 0.963; 95% CI, 0.635 - 1.459, p =0.857), and so was for patients with anemia who had no-reflow phenomenon (OR= 0.939; 95% CI, 0.361 - 2.437, p =0.896). Conclusion: Anemia upon admission was not related with the no-reflow phenomena or in-hospital mortality in STEMI patients undergoing PPCI.
Keywords: STEMI; Primary PCI; Anemia; No-reflow phenomenon; In-hospital mortality