Tesis

Faktor yang Mempengaruhi Oklusi Total Kronik Arteri Koroner pada Pasien Sindrom Koroner Kronik di Rumah Sakit Cipto Mangunkusumo = Factors Influencing Coronary Chronic Total Occlusion in Chronic Coronary Syndrome in Cipto Mangunkusumo General Hospital.

Latar Belakang: Oklusi total kronik (OTK) arteri koroner merupakan manifestasi lanjut dari aterosklerosis yang progresif dan berhubungan dengan morbiditas serta mortalitas kardiovaskular yang tinggi. Faktor-faktor risiko klasik aterosklerosis seperti diabetes melitus, hipertensi, merokok, riwayat sindrom koroner akut (SKA), dan lain-lain diduga berperan terhadap pembentukan OTK pada populasi rentan, namun penelitian mengenai hal ini, termasuk di Indonesia, masih terbatas. Tujuan: Menilai faktor-faktor yang berhubungan dengan kejadian OTK arteri koroner pada pasien sindrom koroner kronik. Metode: Penelitian ini adalah penelitian kasus kontrol dengan perbandingan jumlah subjek 1:2 antar kelompok menggunakan data rekam medis pasien SKK yang menjalani angiografi koroner di laboratorium kateterisasi RSCM periode 2021– 2025. Subjek yang memenuhi kriteria inklusi dan eksklusi dikelompokkan dalam kelompok OTK dan non-OTK, untuk selanjutnya diidentifikasi faktor risiko yang meliputi: usia > 60 tahun, laki-laki, merokok, dislipidemia, diabetes mellitus, hipertensi, penyakit ginjal kronik, obesitas, riwayat intervensi koroner, dan riwayat SA. Analisis bivariat dilakukan menggunakan uji chi-square dan analisis multivariat menggunakan regresi logistik untuk menentukan faktor yang berhubungan dengan OTK. Hasil: Didapatkan 212 subjek yang dikelompokkan menjadi 71 subjek OTK dan 141 subjek non-OTK. Faktor risiko yang paling banyak dijumpai di kelompok OTK adalah: riwayat SKA (94,4%), diabetes mellitus (90,1%), hipertensi (85,95), jenis kelamin laki-laki (80,3%), dan merokok (66,2%). Ditemukan bahwa merokok (OR 6,43, IK95% 2,128 – 19,396; p = 0,001), diabetes mellitus (OR 10,81 , IK95% 3,247 – 35,996; p < 0,001), dan riwayat SKA (OR 50,02, IK95% 14,619 – 171,163; p < 0,001) merupakan faktor risiko independen terhadap kejadian OTK. Kesimpulan: Riwayat SKA, diabetes mellitus, dan merokok merupakan faktor risiko terkuat terhadap kejadian OTK arteri koroner.
Kata Kunci: faktor risiko, oklusi total kronik, sindrom koroner kronik


Introduction: Chronic total occlusion (CTO) of the coronary artery represents an advanced manifestation of progressive atherosclerosis and is associated with significant cardiovascular morbidity and mortality. Conventional atherosclerotic risk factors such as diabetes mellitus, hypertension, smoking, prior acute coronary syndrome (ACS), etc are presumed to play pivotal roles in CTO formation among vulnerable populations. However, research addressing these associations, particularly in Indonesia, remains limited. Aim: To identify the factors associated with the occurrence of coronary artery CTO among patients with chronic coronary syndrome (CCS). Methods: This case–control study used a 1:2 ratio between CTO and non-CTO groups. Data was obtained from medical records of CCS patients who underwent coronary angiography at the cardiac catheterization laboratory of Dr. Cipto Mangunkusumo National General Hospital from 2021 to 2025. Subjects who met the inclusion and exclusion criteria were categorized into CTO and non-CTO groups. Risk factors assessed including: age >60 years, male sex, smoking, dyslipidemia, diabetes mellitus, hypertension, chronic kidney disease, obesity, history of coronary intervention, and prior ACS. Bivariate analysis was performed using the chi-square test, and multivariate analysis employed logistic regression to determine independent factors associated with CTO. Results: A total of 212 subjects were included, consisting of 71 CTO and 141 nonCTO patients. The most prevalent risk factors in the CTO group were prior ACS (94.4%), diabetes mellitus (90.1%), hypertension (85.9%), male sex (80.3%), and smoking (66.2%). Multivariate analysis revealed that smoking (OR 6.43; 95% CI 2.13–19.40; p = 0.001), diabetes mellitus (OR 10.81; 95% CI 3.25–36.00; p < 0.001), and prior ACS (OR 50.02; 95% CI 14.62–171.16; p < 0.001) were independent risk factors for CTO occurrence. Conclusion: Prior acute coronary syndrome, diabetes mellitus, and smoking were the strongest independent risk factors associated with chronic total occlusion of the coronary artery.
Keywords: risk factors, chronic total occlusion, chronic coronary syndrome.