Tesis

Hubungan Kepatuhan Antibiotik Profilaksis Sekunder Terhadap Kejadian Restenosis Katup Mitral dan Peningkatan Skor Wilkins Pasca Komisurotomi Mitral Transvena Perkutan = Secondary Prophylaxis Adherence and Mitral Valve Restenosis and Wilkins Score Increment After Percutaneous Transvenous Mitral Commissurotomy in Rheumatic Mitral Stenosis (PROTECT-RMS study).

Latar Belakang : Stenosis mitral akibat penyakit jantung rematik masih menjadi masalah penting di Indonesia. KMTP merupakan terapi lini pertama, namun restenosis menjadi tantangan jangka panjang. Profilaksis antibiotik sekunder direkomendasikan seumur hidup pada SM berat, tetapi kepatuhan sering rendah dan bukti mengenai kaitannya dengan restenosis pasca-KMTP masih kontroversial. Tujuan : Menilai hubungan kepatuhan profilaksis sekunder dengan kejadian restenosis dan peningkatan skor Wilkins pasca-KMTP. Metode : Studi observasional di RSJPDHK pada pasien dewasa dengan SM berat rematik yang berhasil KMTP periode Januari 2019–Desember 2022 dan memiliki follow-up ekokardiografi ≥1 tahun. Kepatuhan menggunakan persentase delivery (injeksi/oral) dan kuesioner MMAS-8, dibagi kelompok patuh dan tidak patuh. Luaran utama berupa kejadian restenosis dan peningkatan skor Wilkins >2 poin. Hasil : Sebanyak 70 subjek di follow-up dengan waktu median 30 (4-60) bulan dan dilakukan analisis. Rerata usia 48±9 tahun, 72.9% perempuan dengan 70% tidak patuh profilaksis sekunder. Restenosis terjadi pada 65.7% subjek dan peningkatan skor Wilkins pada 37.1%. Ketidakpatuhan berhubungan independen dengan restenosis (HR adjusted 2.15, IK95% 1.02–4.53, nilai P = 0.043) dan peningkatan skor Wilkins (OR adjusted 3.77, IK95% 1.05–13.53, nilai P = 0.042). Kesimpulan : Ketidakpatuhan terhadap profilaksis sekunder berhubungan dengan kejadian restenosis dan peningkatan skor Wilkins pasca-KMTP.
Kata kunci : Stenosis mitral rematik, KMTP, profilaksis sekunder, kepatuhan, restenosis


Background : RMS remains an important health problem in Indonesia. PTMC is the first-line therapy, however, restenosis remains a major long-term challenge. Lifelong secondary prophylaxis is recommended, yet adherence is often challenging and evidence regarding its association with after-PTMC restenosis remains controversial. Objective : To determine the association between adherence to secondary prophylaxis and restenosis and Wilkins score increment after -PTMC. Method : This observational study conducted at NCCHK, Jakarta, involving adult patients with severe RMS who underwent successful PTMC between January 2019 to December 2022 and had echocardiographic follow-up of at least one year. Adherence to secondary prophylaxis was assessed using prophylaxis delivery percentage (injectable/oral) and the MMAS-8, and subjects were categorized as adherent or nonadherent. The primary outcome was mitral valve restenosis and increment of Wilkins score. Results : A total of 70 subjects were followed up for a median duration of 30 (4-60) months and included in the analysis. The mean age 48±9 years, with 72.9% of female, and 70% subject were non-adherent group. Restenosis occurred in 65.7% of subjects and Wilkins score increment was observed in 37.1%. Non-adherence was independently associated with restenosis (adjusted HR 2.15, 95%CI 1.02–4.53, p value = 0.043) and Wilkins score increment (adjusted OR 3.77, 95%CI 1.05–13.53, p value = 0.042). Conclusion : Non-adherence to secondary antibiotic prophylaxis is associated with mitral valve restenosis and Wilkins score increment after PTMC.
Keywords : Rheumatic Mitral Stenosis, PTMC, Secondary prophylaxis, adherence, restenosis