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Penundaan Stent pada Beban Trombus Tinggi: Sebuah Laporan Kasus Kurniawan, Catur; Widito, Sasmojo; Putri, V.Y.S
Jurnal Klinik dan Riset Kesehatan Vol 4 No 2 (2025): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.2.8

Direct stent implantation is widely recommended for the management of patients who have acute myocardial infarction with ST-segment elevation. However, in situations where there is HTB in the affected artery, stenting may increase the risk of no flow phenomenon. Delaying stenting may reduce complications. A 45-year-old man presented with symptoms suggestive of acute right ventricular infarction that started 8 hours before admission. The patient underwent an echocardiogram which showed an ejection fraction of 36%. Pre-PCI pharmacotherapy was administered. Coronary angiography showed a grade IV occlusion in the mid-LAD branch as well as a thrombus in the mid-RCA with TIMI 2 flow. Thrombus aspiration and balloon inflation were performed, but HTB persisted. DS was decided, with additional Enoxaparin 0. 6 cc twice daily. Subsequent angiography after 34 hours, showed CAD in three coronary artery branches with the RCA still showing complete occlusion with HTB. A stent implantation procedure was performed in the mid-RCA segment The final result achieved was TIMI 3 blood flow, with no residual stenosis. HTB can also be diagnosed based on the TIMI thrombus risk classification. The main goal of deferred stenting is to minimize complications such as the slow-flow phenomenon of distal embolization. It is important to emphasize that a routine DS strategy has not shown clear benefit and is not recommended.

Modalitas Pencitraan Non Invasif pada Sindroma Koroner Kronis Indrihapsari, Pratiwi; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 2 (2025): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.2.7

Advancements in non-invasive cardiovascular imaging technology have introduced robust diagnostic modalities for managing cardiovascular diseases. Three prominent techniques in this domain are stress echocardiography, coronary computed tomography angiography (CCTA), cardiac magnetic resonance imaging (CMR), Single Photon Emission Computed Tomography (SPECT), and Positron Emission Tomography (PET). These modalities provide crucial information for accurate diagnosis and optimal therapeutic planning. Stress echocardiography occupies a strategic position in the diagnostic algorithm, particularly in suspected or confirmed cases of coronary artery disease. The strength of this modality lies in its ability to provide a comprehensive picture of myocardial functional status. Meanwhile, CCTA offers superiority in visualizing and characterizing atherosclerotic plaques in coronary vessels, enabling early detection and more precise risk stratification. This literature review aims to explore critical aspects of non-invasive cardiovascular imaging modalities in the context of diagnosing Chronic Coronary Syndrome.

Analysis of activated clotting time in patients receiving unfractionated heparin with and without continuous infusion during elective percutaneous coronary intervention Saidi, Zaki; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.11

Background: Percutaneous coronary intervention (PCI) involves a risk of thrombotic events. Unfractionated heparin (UFH) remains a preferred antithrombotic agent during PCI, though the optimal administration method is still under debate. Given its narrow therapeutic range, UFH requires careful monitoring through the measurement of activated clotting time (ACT) Objective: The aim is to compare ACT value and the outcomes of administering a bolus of UFH at 70–100 IU/kgBW, with and without a continuous infusion of 2000 IU/hour Methods: An observational retrospective study was conducted on 133 patients who underwent elective PCI by meeting the inclusion and exclusion criteria during the period of July 2022–July 2024. Clinical information, ACT value and the outcome were gathered from medical records. Statistical analyses were performed using SPSS 22, employing univariate, bivariate, and multivariate logistic regression analyses to determine correlations. Result: The range of ACT results of administering an UFH bolus of 70-100 IU/kgBW with continuous infusion 2000 IU/hour was 191 to 426 seconds (mean 281.9 seconds). Among the 44 patients, 66.6% exhibited ACT levels below 300 seconds, 15 patients (22.7%) had ACT levels ranging from 300 to 350 seconds, while 6 patients (8.3%) had ACT levels exceeding this range. The percentage of patients who attained therapeutic success in the unfractionated heparin (UFH) infusion group (22.7%) was significantly higher than the UFH bolus group (5.9%) with statistically significant results (p = 0.000). Complications were observed in both groups, with 1 patient in each group experiencing acute thrombosis (p = 1.000) and no patients experienced bleeding complications. Conclusion: Administering a UFH bolus of 70-100 IU/kgBW with continuous UFH infusion at 2000 IU/hour achieved better optimal ACT values. No significant results were found regarding the risk of acute thrombosis with no bleeding complications.

The influence of renal insufficiency on in-hospital major adverse cardiovascular events in STEMI patients receiving primary percutaneous coronary intervention Anjarwani, Setyasih; Nurudinulloh, Akhmad Isna; Widito, Sasmojo; Gunawan, Atma; Prasetya, Indra
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.12

Introduction: Renal insufficiency (RI) is related to poor clinical results in STEMI patients receiving primary percutaneous coronary interventions (PCI). Objectives: This study evaluates the effect of RI on in-hospital major adverse cardiovascular events (MACE) in STEMI patients receiving primary PCI. Methods: The study was predicated on the registry of 1447 STEMI patients from January 2020–December 2023. Study samples were categorized into two groups: RI (eGFR<60mL/min/1.73m²) and no RI (eGFR≥60mL/min/1.73m²). Patients’ characteristics and in-hospital MACE in the two groups underwent analysis. Results: Among 848 consecutive subjects, 238 (28%) had RI, and 610 (72%) had no RI. Age (p = 0.000), diabetes mellitus (p = 0.007), and onset STEMI>12 hours (0.043) were correlated with RI. Dyslipidemia (p = 0.025), Onset STEMI>12 hours (p = 0.006), and RI (p = 0.000) were correlated with MACE. RI was correlated with MACE (OR 2.04, 95% CI: 1.46–2.85, p = 0.000). RI was correlated with sub-group analysis of MACE; cardiogenic shock (OR 2.00, 95% CI: 1.34-2.99, p = 0.001), acute heart failure (OR 1.80, 95% CI: 1.22-2.65, p = 0.003), malignant arrhythmia (OR 2.40, 95% CI: 1.61-3.58, p = 0.000), and mortality (OR 2.74, 95% CI: 1.78-4.24, p = 0.000). Conclusions: RI was correlated with in-hospital MACE in STEMI patients receiving primary PCI. In a sub-group analysis of in-hospital MACE, RI constituted a strong independent predictor of cardiogenic shock, acute heart failure, malignant arrhythmia, and mortality, respectively.

Myocardial Bridging: Tinjauan Mendalam Mengenai Anomali Koroner Widito, Sasmojo; Nurudinulloh, Akhmad Isna
Jurnal Klinik dan Riset Kesehatan Vol 3 No 3 (2024): Edisi Juni
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.03.5

Myocardial bridging (MB) is a congenital coronary anomaly where segment of the epicardial coronary artery traverses through the myocardium for a portion of its length. While traditionally regarded as a benign condition, there is a growing focus on specific subsets of MB associated with ischemic symptoms and requires treatment. Increasing attention is being given to speciﬁc subsets of MB associated with ischemic symptomatology. The emergence of modern functional and anatomical imaging techniques; coronary angiography, coronary computed tomography angiography (CCTA), instantaneous wave-free ratio (iFR), dan diastolic fractional flow reserve (dFFR), has improved our capacity to characterize symptoms associated with MB. In cases involving symptomatic patients, medical therapy often represents an effective treatment option. For individuals who do not respond satisfactorily to medical interventions, comprehensive multimodal assessment; percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and myotomy should be considered.

Penundaan Stent pada Beban Trombus Tinggi: Sebuah Laporan Kasus Kurniawan, Catur; Widito, Sasmojo; Putri, V.Y.S
Jurnal Klinik dan Riset Kesehatan Vol 4 No 2 (2025): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.2.8

Direct stent implantation is widely recommended for the management of patients who have acute myocardial infarction with ST-segment elevation. However, in situations where there is HTB in the affected artery, stenting may increase the risk of no flow phenomenon. Delaying stenting may reduce complications. A 45-year-old man presented with symptoms suggestive of acute right ventricular infarction that started 8 hours before admission. The patient underwent an echocardiogram which showed an ejection fraction of 36%. Pre-PCI pharmacotherapy was administered. Coronary angiography showed a grade IV occlusion in the mid-LAD branch as well as a thrombus in the mid-RCA with TIMI 2 flow. Thrombus aspiration and balloon inflation were performed, but HTB persisted. DS was decided, with additional Enoxaparin 0. 6 cc twice daily. Subsequent angiography after 34 hours, showed CAD in three coronary artery branches with the RCA still showing complete occlusion with HTB. A stent implantation procedure was performed in the mid-RCA segment The final result achieved was TIMI 3 blood flow, with no residual stenosis. HTB can also be diagnosed based on the TIMI thrombus risk classification. The main goal of deferred stenting is to minimize complications such as the slow-flow phenomenon of distal embolization. It is important to emphasize that a routine DS strategy has not shown clear benefit and is not recommended.

Sebuah Penundaan Pemasangan Stent pada Beban Trombosis Tinggi Kurniawan, Catur Rizky; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 3 (2025): Volume 4 No 3, Juni 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.3.5

Deferred stenting is a revascularization strategy that involves two stages of implementation, where stent placement is delayed for a predetermined period after stable coronary blood flow is achieved. This approach aims to reduce the risk of complications such as slow-flow or no-reflow phenomena, particularly in patients with high thrombus burden (HTB). This study seeks to explore the benefits and limitations of deferred stenting in HTB cases, as well as its impact on long-term clinical outcomes. The primary benefits of deferred stenting include significant reduction in thrombus burden, improved myocardial perfusion quality, and decreased risk of complications such as distal embolization and slow-flow phenomena. Research indicates that this technique can enhance left ventricular ejection fraction (LVEF) and reduce infarct size. However, deferred stenting also carries potential complications, including the risk of re-occlusion, need for unplanned revascularization, and increased bleeding risk due to prolonged use of parenteral anticoagulants. Evaluation of various studies reveals inconsistent results regarding the effectiveness of deferred stenting. Some studies report significant benefits in reducing thrombus burden and improving clinical outcomes, while others highlight a higher risk of complications without meaningful short-term improvements. The CRUSADE score is used to assess bleeding risk in HTB patients, with scores >20 indicating a high bleeding risk and contraindicating the use of GPIIb/IIIa inhibitors. Overall, deferred stenting offers potential benefits in HTB cases, its implementation should be carefully considered due to associated risks and additional costs. Further research is needed to determine the optimal protocols and assess the long-term benefits of this technique.

Modalitas Pencitraan Non Invasif pada Sindroma Koroner Kronis Indrihapsari, Pratiwi; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 2 (2025): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.2.7

Advancements in non-invasive cardiovascular imaging technology have introduced robust diagnostic modalities for managing cardiovascular diseases. Three prominent techniques in this domain are stress echocardiography, coronary computed tomography angiography (CCTA), cardiac magnetic resonance imaging (CMR), Single Photon Emission Computed Tomography (SPECT), and Positron Emission Tomography (PET). These modalities provide crucial information for accurate diagnosis and optimal therapeutic planning. Stress echocardiography occupies a strategic position in the diagnostic algorithm, particularly in suspected or confirmed cases of coronary artery disease. The strength of this modality lies in its ability to provide a comprehensive picture of myocardial functional status. Meanwhile, CCTA offers superiority in visualizing and characterizing atherosclerotic plaques in coronary vessels, enabling early detection and more precise risk stratification. This literature review aims to explore critical aspects of non-invasive cardiovascular imaging modalities in the context of diagnosing Chronic Coronary Syndrome.

TERAPI HEPARIN TIDAK TERFRAKSI PADA PROSEDUR INTERVENSI KORONER PERKUTAN ELEKTIF saidi, zaki; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 3 (2025): Volume 4 No 3, Juni 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.3.6

Coronary artery Disease (CAD) occurs due to an imbalance between myocardial oxygen demand and supply due to total or partial blockage of the coronary artery. Occlusion of coronary artery blood vessels in CAD patients requires revascularization to restore blood flow and myocardial perfusion. One of the mechanical revascularization efforts is to perform a percutaneous coronary intervention (PCI) procedure. This technique involves the use of a guided catheter directed to the location of the coronary artery blockage, followed by balloon dilation and stent placement to maintain patency. Blood vessel injury during PCI exposes serine proteases to tissue factor and collagen, stimulating procoagulants that will activate the coagulation cascade. In CAD patients undergoing PCI therapy, periprocedural pharmacotherapy is given in the form of antiplatelet therapy accompanied by intravenous anticoagulants such as unfractionated heparin. Unfractionated heparin produces its main anticoagulant effect by inactivating thrombin and activating factor X (factor Xa) through a mechanism dependent on antithrombin (AT). Intravenous administration of unfractionated heparin in addition to producing anticoagulant effects can also increase the risk of bleeding. In order for the drug to effectively prevent clotting and not cause bleeding, it is necessary to determine the right dose. In connection with this, it is necessary to monitor hemostasis function with optimal Activated Clotting Time (ACT) values to prevent the risk of thrombosis and bleeding in patients undergoing PCI.

Kewaspadaan terhadap Kejadian Stroke pada Pasien Pasca Bedah Pintas Arteri Koroner saidi, zaki; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 5 No 1 (2025): Edisi Oktober 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.05.1.9

Coronary artery bypass grafting (CABG) is a leading cause of iatrogenic stroke. According to the literature, the incidence of stroke following CABG ranges from 1.1% to 5.7%, with most strokes occurring within the first 48 hours after surgery. The risk of stroke after CABG is associated with a significantly higher mortality rate. A 62-year-old male patient with risk factors including hypertension and diabetes mellitus, as well as coronary artery disease 3 vessel disease left main disease (CAD3VD LM disease), was scheduled for CABG. Preoperative data indicated cardiomegaly on chest X-ray, normal carotid and extremity duplex ultrasonography, and echocardiography revealed a decreased ejection fraction and Regional Wall Motion Abnormality (RWMA). The CABG procedure lasted 7 hours and was performed using an on-pump technique, with cardiopulmonary bypass (CPB) time of 232 minutes and aortic clamp time of 123 minutes. Two days after the CABG, the patient developed complications in the form of an infarct stroke, which was confirmed by CT imaging. The stroke led to a prolonged hospitalization period, totaling 14 days. The mechanism of post-CABG stroke is divided into embolic and hypoperfusion processes, both influenced by various risk factors. In this patient, risk factors such as hypertension, type II Diabetes Mellitus, decreased ejection fraction, and perioperative factors such as prolonged CPB and aortic clamp times, along with aortic manipulation during the on-pump procedure, contributed to the increased risk of stroke.

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