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All Journal Indonesian Journal of Cardiology Heart Science Journal Narra J Jurnal Klinik dan Riset Kesehatan Deka in Medicine
Anjarwani, Setyasih
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry Juzar, Dafsah Arifa; Muzakkir, Akhtar Fajar; Ilhami, Yose Ramda; Taufiq, Nahar; Astiawati, Tri; R A, I Made Junior; Pramudyo, Miftah; Priyana, Andria; Hakim, Afdhalun; Anjarwani, Setyasih; Endang, Jusup; Widyantoro, Bambang
Jurnal Kardiologi Indonesia Vol 43 No 2 (2022): Indonesian Journal of Cardiology: April - June 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1406

Abstract

Background Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia. Methods IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes. Results Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%). Conclusion Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.
CARDIOPROTECTIVE EFFECT OF REMOTE ISCHEMIC PRECONDITIONING: FROM BENCH TO BEDSIDE Suprayoga, Imam Mi'raj; Anjarwani, Setyasih
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.6

Abstract

Remote ischemic preconditioning (rIPC) refers to a cardioprotective phenomenon in which short episodes of ischemia, followed by reperfusion, in one organ or tissue might provide future protection against ischemia/reperfusion damage in other organs, namely the heart. The process involves the activation of humoral, neural, or systemic communication channels, which in turn induce various intracellular signals inside the heart. The primary objective of this review is to provide a concise overview of the potential processes implicated in rIPC cardioprotection, as well as to elucidate current clinical studies aimed at establishing the effectiveness of these techniques in safeguarding the heart from detrimental ischemia/reperfusion injury. In this context, many variables contribute to the attenuation of subcellular processes of rIPC in patients, including advanced age, presence of comorbidities, medication use, and variations in anaesthetic protocols. These factors may account for the observed variability in outcomes across different clinical studies. Additional research, meticulously planned, is needed in order to enhance our comprehension of the pathways and mechanisms associated with both early and late rIPC. A comprehensive understanding of the various routes is crucial in facilitating the translation of medical advancements to the benefit of patients.
Validation of Self-Assessment-Based Chest Pain Algorithm (DETAK) as An Early Identification Tool for Acute Coronary Syndrome Nugraha, Krishna Ari; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Anjarwani, Setyasih; Rizal, Ardian; Astiawati, Tri; Adi, Andi Wahjono; Haryati, Lina
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.5

Abstract

BackgroundThe most common reason of prehospital delay in ACS patients is inability to pay attention to symptoms in order to act fast and effectively. Patient oriented machine learning algorithms has the opportunity to reduce the total ischemic time, that determines the clinical outcome of ACS patients.AimAssessing the accuracy of the chest pain self-assessment algorithm (DETAK) in identifying ACS.MethodThis study included seven hospitals, five PCI capable hospitals and two of non-PCI capable hospitals. The study was conducted from August 2021 to June 2022. The study included all patients with chest pain who visited the hospital and used the DETAK algorithm. Patients were interviewed after being confirmed hemodynamically stable. Patients with UAP, as well as those who died or declined to participate in this study were excluded. The area under the curve receiver operating characteristic (AUROC) was used to verify DETAK's performance in identifying SKA. We compare the DETAK algorithm's diagnosis with the definitive diagnostic based on ECG and/or troponin results.ResultsA total of 539 patients (mean age 58 years) with a higher proportion of male patients (n=424). An AUC value of 0.854 was obtained, where the cut of point accuracy of DETAK in identifying ACS for the entire sample had a sensitivity of 89.5% and a specificity of 81.2%. The algorithm's specificity decreased in certain subgroups, including type 2 diabetes (79.4%), women (77.3%), and hypertensive patients (80.9%). Algorithm reliability test obtained moderate to strong level of agreement values.ConclusionDETAK's self-assessment-based chest pain algorithm offers an excellent diagnostic performance in early identification of ACS.
The role of exercised-based cardiac rehabilitation in unrevascularized complex coronary artery disease patients: a case series Aryanugraha, Teguh; Tjahjono, Cholid Tri; Mayangsari, Veny; Satrijo, Budi; Anjarwani, Setyasih
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.13

Abstract

Background: Coronary artery disease (CAD) is a common type of heart disease that elevates the risk of morbidity and mortality significantly. Although revascularization techniques like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are advised for CAD patients, some people may not be eligible for or choose not to undergo revascularization. Even though cardiac rehabilitation (CR) enhances cardiovascular outcomes, quality of life, and general well-being, the utilization of CR is still very low.Case illustration: The first patient was a 72-year-old man, and the second patient was a 60-year-old man. They were referred for CR after refusing revascularization, and both are left-main and three-vessel disease patients. The first patient underwent CR for six months and the second patient for 18 months, then the Six Minutes Walking Test (6MWT) and 36-Item Short Form Health Survey (SF-36) were performed before and following CR. The evaluation is an increase in walking distance and patient quality of life.Conclusion: By enhancing quality of life, exercised-based CR programs offer an approach to managing CAD, especially in those who may not be suitable candidates for or choose to avoid revascularization procedures.
Utilizing APACHE IV and GRACE Scores as Predictors of Mortality Compared with SAPS-3 Scores for Acute Coronary Syndrome Patients in the Cardiac Vascular Care Unit Nugraha, Tria Yudha; Prasetya, Indra; Anjarwani, Setyasih
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.8

Abstract

Background: Acute coronary syndromes (ACS) frequent cause of hospitalization in the cardiovascular care unit. Positive predictive data are being developed and shown to be effective for patients with ACS; the Global Registry of Acute Coronary Events, or GRACE, has shown the most accurate outcomes. In contrast, prognostic scores derived from diverse cohorts of critically ill patients are predominantly employed by intensive care clinicians. Prominent examples of such scores include APACHE IV and SAPS 3. The objective of this research endeavor was to assess and contrast the efficacy of these three scores across an unselected sample of ACS cases.Objective: The Cardiovascular Care Unit of RSUD Dr. Saiful Anwar Malang treats Acute Coronary Syndrome patients. This study compares SAPS 3, GRACE, and APACHE IV score parameters through calibration and discrimination tests to predict patient mortality.Methods: The study included all ACS patients admitted from August 2021 to November 2023. Hospital mortality prediction was assessed using score calibration and discrimination.Results: There were 843 patients in total included. SAPS 3 could not be calibrated appropriately, whereas APACHE IV and GRACE could. Across all scores, discrimination was exceptional (area under the curve values of 0.811 for APACHE IV, 0.740 for GRACE, and 0.732 for SAPS 3).Conclusions: GRACE and APACHE IV were calibrated thoroughly in this cohort of intensive care unit-admitted ACS patients; however, SAPS 3 lacked such calibration. All three scores exhibited exceptional discrimination. GRACE and APACHE IV may be utilized to predict the risk of mortality in patients with ACS.
Weaning Failure in Mechanical Ventilation: a Literature Review Sakti, Pradhika Perdana; Anjarwani, Setyasih
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.2

Abstract

Mechanical ventilation is a method of ventilation support through positive pressure breath application. It is used in cases of ventilation and/ or oxygenation failure. Due to its related complications mechanical ventilation should be withdrawn from the patient as soon as possible, called a weaning process. The result of the weaning of mechanical ventilation determines the patient’s prognosis. Patient will go through several assessments before a weaning decision is made. Subsequently, patient will be placed on an unconstrained breathing test (SBT) to check whether the patient's respiratory muscle is equipped for accepting its work of relaxing. Weaning disappointment is characterized as disappointment on SBT or reintubation at 48 hours following extubation. Several factors related to weaning failure are increasing airflow resistance, decreasing compliance, respiratory muscle fatigue, and the patient’s underlying conditions. Techniques to conquer these variables are expected to lessen the pace of disappointment of the weaning system.
Effects of the Low-Dose Colchicine Regimen on Left Ventricular Adverse Remodeling and Systolic Function in Acute Myocardial Infarction Patients With Anterior ST Segment Elevation Undergoing Primary Percutaneous Coronary Intervention: A Randomized Controlled Trial Caesario, Fahreza; Prasetya, Indra; Rohman, Mohammad Saifur; satrijo, Budi; Anjarwani, Setyasih
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.9

Abstract

Background: Inflammation in reperfusion injury results in adverse ventricular remodeling and reduced systolic function. The anti-inflammatory effects of colchicine have shown beneficial effects in cardiovascular disease.Objective: To determine the effects of low-dose colchicine on left ventricular (LV) adverse remodeling and systolic function in acute myocardial infarction with anterior ST-segment elevation (anterior STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).Material and Methods: This prospective, randomized, double-blinded study randomly assigned anterior STEMI patients who underwent PPCI to receive either low-dose colchicine (1mg loading dose followed by 0.5mg daily) or a matching placebo for 30 days in addition to standard therapy. Outcomes included adverse LV remodeling and systolic function, determined by transthoracic echocardiography (TTE) in the first and third month.Result: Enrollment comprised 196 patients, with 92 patients in the colchicine group and 104 patients in the placebo group. Adverse LV remodeling and a decrease in systolic function were observed in both groups. No significant differences in LV remodeling were observed between the colchicine and placebo groups, as indicated by the change in LV end-systolic volume index (LVESVI) at the first month (16.5% vs. 18.25% [p=0.091]) and third month (19.5% vs. 21.5% [p=0.124]). Similar results were found in LV systolic function between the colchicine and placebo groups, with a reduction in LV ejection fraction (LVEF) observed in the first month (6.3% vs. 8.95% [p=0.083]) and third month (9.5% vs. 11.5% [p=0.163]). Diarrhea was the only reported side effect, occurring in 6.5% of patients in the colchicine group.Conclusion: Low-dose colchicine administration in anterior STEMI patients undergoing PPCI did not reduce LV adverse remodeling or systolic function.
The Relationship Between Cha2ds2-Vasc Scores And The Degree of TIMI Flow in Patients With Acute St-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention at Dr. Saiful Anwar Malang Aji, Bayu; Widito, Sasmojo; Anjarwani, Setyasih; Kurnianingsih, Novi; Ruspiono, Evit
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.10

Abstract

Background: Suboptimal reperfusion of the compromised myocardium in the area of the culprit coronary arteries is one of the main problems associated with primary PCI that need reliable risk stratification methods to accurately predict the occurrence of decreased TIMI flow given its complex pathophysiology. Some parameters are included CHA2DS2-VASc score.Objective: To understand the relationship between CHA2DS2-VASc and the decreased TIMI flow in STE-ACS patients who had underwent primary PCI at RSUD dr. Saiful Anwar Malang.Material and Methods: The study was cohort retrospective with the inclusion criteria being all STE-ACS patients who underwent primary PCI in RSUD Dr. Saiful Anwar Malang from January 2018 – August 2023. Patients were assigned to TIMI flow grade <3 group (N =169) and TIMI flow grade 3 (N = 677) according to TIMI Flow degree after primary PCI. All the patient’s angiogram were evaluated for TIMI score and CHA2DS2-VASc score is based on a guideline. We concluded data in SPSS program and used the Spearman test and p value of .05 was considered as significant.Result: From a total sample of 846 patients, the correlation between STE-ACS onset and TIMI flow indicates that a higher number of patients with STE-ACS onset <12 hours was found in the TIMI flow <3 and 3 groups (p=0.000). The cutoff CHA2DS2 VASC score's sensitivity and specificity values were ascertained using ROC analysis with cut off value 2.5. The incidence of decreased TIMI flow rate was more significant in the CHA2DS2-VASc ≥3 group with DM (+) and age ≥64 (OR value 0.156, p=0.000) than in the CHA2DS2-VASc ≥3 group without DM and age < 64. With an OR value of 2.94 (p=0.000), Killip class > 2 is another powerful predictor of lower TIMI flow.Conclusion: The only variables in the CHA2DS2-VASc score component that are most strongly associated with the risk of reducing the degree of TIMI flow are DM, age, and Killip class.
The Association between CHA2DS2-VASc Score with Increased Serum Creatinine Level in ACS Patients Undergoing PCI at RSUD dr. Saiful Anwar Malang Fathoni, Emil; Widito, Sasmojo; Anjarwani, Setyasih; Satrijo, Budi; Putri, Valerinna Yogibuana Swastika
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.4

Abstract

Background: The current literature on the relationship between the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA or thromboembolism, vascular disease, age, sex category (CHA2DS2-VASc) score and increased Serum Creatinine (SCr) among Acute coronary syndrome (ACS) patients is noticeably limited in scope. Therefore, the primary objective of this study was to assess the correlation between CHA2DS2-VASc score with increased of Serum Creatinine in patients with ACS undergoing Percutaneous coronary intervention (PCI) procedures.Material and Methods: In this study, a total of 527 participants were recruited, comprising two groups: Increased SCr level (n=159) and normal SCr level (n=368). Data pertaining to clinical information and demographic characteristics, such as gender, age, diabetes mellitus (DM), hypertension (HT), congestive heart failure (CHF), history of stroke or transient ischemic attack (TIA), and vascular disease, were gathered from various sources, including registry data and medical records, diagnostic physical examination, electrocardiography and laboratory records. Logistic regression analysis was employed to assess the association between the CHA2DS2-VASc score and the incidence of increased SCr level.Result: In our study, we observed that the CHA2DS2-VASc scores were significantly higher in the group of patients who increase SCr level compared to those who did not increase SCr level. Furthermore, our Receiver Operating Characteristic (ROC) analysis revealed that a CHA2DS2-VASc score cutoff of 3 was determined to be the optimal threshold for estimating the increased SCr level (AUC= 0.805, 95% CI 0.762-0.848; p<0.01).Conclusion: The CHA2DS2-VASc score serves as a valuable tool for estimating the likelihood of SCr in patients undergoing PCI, offering a foundational assessment. Additionally, in PCI patients, an increase in the CHA2DS2-VASc score exceeding 3 is indicative of a heightened incidence of increased SCr level.
Neutrophil-Lymphocyte Ratio (NLR) as A Predictor for Non-ST Elevation Myocardial Infarction (NSTEMI) in the Emergency Room Zunardi, Lutfi Hafiz; Anjarwani, Setyasih; Prasetya, Indra; Satrijo, Budi; Rahimah, Anna Fuji
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.7

Abstract

AbstractBackground: The usefulness of the NLR as an approach to identifying cases of acute coronary syndrome (ACS) needs to be improved.Objective: This research was designed to determine the effectiveness of the NLR in identifying individuals who presented to the emergency room complaining of anginal due to ACS.Methods: The single-center cross-sectional study was performed at Saiful Anwar General Hospital in Malang, East Java, Indonesia, from July 2020 to December 2023. Patients were involved in this study with complaints of angina suspected of ACS. During further observation in the emergency room, based on the findings of the troponin I analysis, individuals were divided into unstable angina pectoris (UAP) and NSTEMI.Results: Study results were collected from 282 individuals diagnosed with Non-ST Elevation Acute Coronary Syndrome (NSTEACS), with 75.9% male and a mean age of 58.39 ± 10.27 years. The NLR threshold was 4.5 (AUC: 0.78, 95% CI: 0.765–0.867, P <.001) assessed during admission, which showed a sensitivity of 79% and a specificity of 78% in accurately predicting the probability of subsequent troponin positivity. Multivariate analysis revealed that the NLR at hospitalization remained an essential marker of troponin positivity during follow-up.Conclusions: In the end, NLR could be considered an initial test in emergency services to predict the diagnosis of NSTEMI in people experiencing angina. 
Co-Authors Adi, Andi Wahjono Afifah, Yuri AJI, BAYU Andria Priyana Aryanugraha, Teguh Ashari, Yordan Wicaksono Astiawati, Tri Atma Gunawan Bagaswoto, Hendry P. Bambang Widyantoro Baskoro, Shalahuddin Suryo Caesario, Fahreza Cholid Tri Tjahjono Danny, Siska S. Dewi U. Djafar, Dewi U. Djanggan Sargowo Emil Fathoni, Emil Endang, Jusup Galih Prakosa, Ardani Habib, Faisal Hakim, Afdhalun Hakim, Dennis I. Hakim, Dennis Ievan Haryati, Lina Hendry Purnasidha Bagaswoto Ilhami, Yose R. Ilhami, Yose Ramda Indra Prasetya Iskandar Iskandar Ispar, Akhtar Fajar Muzakkir Ali Juzar, Dafsah A. Juzar, Dafsah Arifa Karolina, Wella Kurnianingsih, Novi Kurniawan, Dea Arie Lestari, Puspa Martini, Heny Mayangsari, Veny Mazwar, Irmaliyas Mohammad S. Rohman Mohammad Saifur Rohman Muzakkir, Akhtar F. Muzakkir, Akhtar Fajar Nahar Taufiq, Nahar Nugraha, Krishna Ari Nugraha, Tria Yudha Nugraha, Yudha Tria Nurudinulloh, Akhmad Isna Pashira, Andranissa Amalia Pramudyo, Miftah Pratama, Vireza Pratiwi, Irma Kamelia Putra, Iwan Cahyo Santosa Putri, Valerinna Yogibuana Swastika R A, I Made Junior Raharjo, Fajar Rahimah, Anna Fuji Rizal, Ardian Rosyidi, Muhammad Azhar Ruspiono, Evit Sakti, Pradhika Perdana Saskia Dyah Handari Satrijo, Budi Setiawan, Dion Siska Suridanda Danny Sungkar, Safir Suprayoga, Imam Mi'raj Swastika Putri, Valerinna Yogibuana Vori, Ira Widito, Sasmojo Wirawan, Hendy Yogibuana, Valerinna Yudha, Tria Zulkarnain, Edrian zunardi, Lutfi hafiz