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Obat-Obat Antitrombotik yang Digunakan pada Pasien Infark Miokard Akut di Rsup Mohammad Hoesin Palembang Ni Wayan Puspa Pandani; Taufik Indrajaya; Rizma Adlia Syakurah
Biomedical Journal of Indonesia Vol. 4 No. 3 (2018): Biomedical Journal of Indonesia
Publisher : Fakultas Kedokteran Universitas Sriwijaya (Faculty of Medicine, Universitas Sriwijaya) Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar

Infark miokard akut (IMA) adalah kelanjutan dari nekrosis otot jantung yang disebabkan oleh ketidakseimbanganantara suplai dan kebutuhan otot jantung. Obat antitrombotik merupakan salah satu dari serangkaianpenatalaksanaan IMA. Antitrombotik adalah obat yang dapat menghambat agregasi trombosit sehingga menyebabkanterhambatnya pembentukan trombus pada pembuluh darah. Tujuan penelitian ini adalah mengetahui jenis obatantitrombotik yang digunakan pada pasien IMA di RSUP Mohammad Hoesin Palembang pada tahun 2012. Jenispenelitian yang dilakukan adalah jenis deskriptif observasional. Populasi pada penelitian ini adalah rekam medik diRSUP Mohammad Hoesin Palembang. Sampel pada penelitian ini adalah seluruh rekam medik pasien yang didiagnosaIMA di Bagian Kardiovaskular tahun 2012 yang mencantumkan tatalaksana antitrombotik. Data disajikan dalambentuk tabel yang diolah dengan bantuan komputer menggunakan program microsoft word office. Data yang disajikanakan menunjukkan persentase penggunaan obat-obat antitrombotik. Dari 18 rekam medik yang diamati, obatantitrombotik yang digunakan adalah golongan aspirin 53,3%; heparin 23,3%; clopidogrel 13,3%; dan fondaparinux10%. Aspirin menjadi pilihan utama dalam terapi antitrombotik pasien IMA, sesuai dengan berbagai literature yangmenyebutkan aspirin direkomendasikan pada pasien Non-STEMI tanpa kontraindikasi, serta merupakan antiplateletstandar pada STEMI yang direkomendasikan ACC/AHA. Jadi simpulan akhir penelitian ini, obat antitrombotik yangdigunakan pada pasien IMA di RSUP Mohammad Hoesin Palembang tahun 2012 adalah aspirin, heparin, clopidogreldan fondaparinux.

Reperfusion Arrhythmia in Acute Myocardial Infarction Setiadi, Teguh; Taufik Indrajaya; Ali Ghanie; Ferry Usnizar; Erwin Sukandi; Syamsu Indra; Erwin Azmar; Rukiah Chodilawati; Imran Soleh; Yudhie Tanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.894

Management of reperfusion in acute myocardial infarction is an important component of myocardial cell survival to minimize the area experiencing infarction and improve patient clinical outcomes. However, this reperfusion also contributes to myocardial injury which is preceded by the ischemic process. One of the injuries related to the ischemia-reperfusion process in the myocardium is reperfusion arrhythmia. Reperfusion arrhythmias from several studies can begin to occur in the first minutes after restoration of obstructed coronary flow. The features of reperfusion arrhythmia can include accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, and other arrhythmias. The mechanism of reperfusion arrhythmia can be excess calcium in the cells, oxidative stress due to an increase reactive oxygen species, energy metabolism disorders, and neutrophil accumulation. Excessive intracellular calcium and other mechanisms cause a delay in the depolarization of previously ischemic cells. This reperfusion arrhythmia requires special attention because it can disrupt hemodynamics and patient outcomes after reperfusion procedures. Knowledge of the mechanisms of reperfusion arrhythmias will guide clinicians to provide better management during and after reperfusion procedures.

Novel Insights into the Pathophysiology of Coronary Slow Flow Phenomenon: The Role of Triglycerides-Glucose Index and Electrocardiogram Risk Score in Subclinical Atherosclerosis Kusuma, Singgih; Erwin Sukandi; Taufik Indrajaya; Ferry Usnizar; Irfannuddin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1228

Background: Coronary slow flow phenomenon (CSFP) is characterized by delayed distal coronary vessel opacification without significant epicardial coronary stenosis. The underlying mechanisms of CSFP remain unclear, but subclinical atherosclerosis is a likely contributor. This study investigated the relationship between the Triglycerides-Glucose Index (TyG), Electrocardiogram Risk Score (ERS), and carotid intima-media thickness (CIMT) in CSFP patients. Methods: This cross-sectional study involved 31 patients diagnosed with CSFP at Dr. Mohammad Hoesin General Hospital Palembang. CSFP was determined based on coronary blood flow slowdown on angiography. Data collection included anamnesis, physical examination, laboratory tests, echocardiography, and CIMT measurement. Statistical analysis was performed using SPSS 27. Results: The majority of CSFP patients were male (51.6%) with a mean age of 50.87 ± 13.94 years. Dyslipidemia was the most prevalent risk factor (77.4%), followed by hypertension (35.5%), smoking (22.6%), and diabetes mellitus (6.5%). Statistical analysis revealed significant positive correlations between TyG index and CIMT (r = 0.445, p = 0.012), and between ERS and CIMT (r = 0.476, p = 0.007). Conclusion: TyG and ERS indices are positively correlated with CIMT in CSFP patients. These indices may be useful tools for cardiovascular risk evaluation and early identification of high-risk patients for subclinical atherosclerosis and potential CSFP.

eNOS, Cardiac Senescence, and Cardiovascular Aging: A Meta-Analysis of Molecular Mechanisms and Clinical Outcomes Tri Nisdian Wardiah; Ali Zainal Abidin; Taufik Indrajaya; Nur Riviati
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 6 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i6.685

Endothelial nitric oxide synthase (eNOS) plays a critical role in maintaining cardiovascular homeostasis. Its dysfunction is implicated in cardiac senescence, a hallmark of aging characterized by cellular decline and increased risk of cardiovascular disease. This meta-analysis investigated the association between eNOS, cardiac senescence, and cardiovascular aging, exploring underlying molecular mechanisms and clinical outcomes. A systematic search of PubMed, Scopus, and Web of Science databases was conducted for relevant studies published between 2013 and 2024. Studies investigating the relationship between eNOS, cardiac senescence markers (e.g., telomere length, p53, p16), and cardiovascular outcomes (e.g., heart failure, myocardial infarction, stroke) were included. Data were extracted and pooled using random-effects models. Nine studies (n=4,875 participants) met the inclusion criteria. Meta-analysis revealed a significant association between reduced eNOS activity and increased cardiac senescence markers (standardized mean difference [SMD] = -0.85; 95% confidence interval [CI], -1.20 to -0.50; p<0.001). Furthermore, eNOS dysfunction was associated with an increased risk of cardiovascular events (relative risk [RR] = 1.62; 95% CI, 1.25 to 2.10; p=0.001). Molecular analysis indicated that eNOS dysfunction contributes to cardiac senescence through increased oxidative stress, inflammation, and impaired autophagy. In conclusion, this meta-analysis provides compelling evidence for the detrimental role of eNOS dysfunction in cardiac senescence and cardiovascular aging. Targeting eNOS may offer promising therapeutic strategies to mitigate age-related cardiovascular decline.

Targeting Interleukin-6 Signaling with Tocilizumab in Atherosclerosis: A Meta-Analysis of Anti-Inflammatory Effects and Plaque Stabilization Ali Zainal Abidin; Tri Nisdian Wardiah; Taufik Indrajaya; Nur Riviati
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i1.686

Atherosclerosis, a chronic inflammatory disease, is the leading cause of cardiovascular disease. Interleukin-6 (IL-6) plays a crucial role in atherogenesis, making it a potential therapeutic target. Tocilizumab, an IL-6 receptor antagonist, has shown promise in reducing inflammation and stabilizing atherosclerotic plaques. This meta-analysis aimed to evaluate the efficacy and safety of tocilizumab in atherosclerosis by analyzing its impact on inflammatory markers and plaque characteristics. A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to January 2024. Studies evaluating the effects of tocilizumab on inflammatory markers and plaque characteristics in patients with atherosclerosis were included. Randomized controlled trials (RCTs) and observational studies with a comparative arm were eligible. Data were extracted and pooled using a random-effects model. Nine studies (n=1248 participants) met the inclusion criteria. Tocilizumab significantly reduced CRP levels (standardized mean difference [SMD] -1.23; 95% confidence interval [CI] -1.56 to -0.90; p<0.001) and IL-6 levels (SMD -0.87; 95% CI -1.12 to -0.62; p<0.001) compared to control groups. A significant reduction in plaque volume (SMD -0.45; 95% CI -0.71 to -0.19; p=0.001) and an increase in fibrous cap thickness (SMD 0.38; 95% CI 0.12 to 0.64; p=0.004) were also observed. No significant increase in adverse events was reported in the tocilizumab group. This meta-analysis demonstrates that tocilizumab effectively reduces inflammation and promotes plaque stabilization in atherosclerosis. These findings suggest that tocilizumab may be a promising therapeutic strategy for preventing cardiovascular events in patients with atherosclerosis. Further large-scale RCTs are needed to confirm these findings and establish the long-term safety and efficacy of tocilizumab in this population.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

Beyond Cholesterol: The Independent Roles of Inflammation and Renal Dysfunction in Carotid Atherosclerosis Among Indonesian Elders Rukiah Chodilawati; Taufik Indrajaya; Ferry Usnizar; Sudarto; Irsan Saleh
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1386

Background: Atherosclerosis remains a leading cause of mortality in aging populations, driven by a complex interplay of metabolic and inflammatory factors. While dyslipidemia is a cornerstone of risk, the contributions of systemic inflammation, marked by high-sensitivity C-reactive protein (hsCRP), and declining renal function are increasingly recognized. This study aimed to elucidate the independent associations of hsCRP, dyslipidemia, and renal function with the presence of carotid atherosclerosis in an understudied elderly Indonesian population. Methods: We conducted a single-center, case-control study at a tertiary hospital in Palembang, Indonesia, from January to June 2024. One hundred participants aged ≥60 years were enrolled from the geriatric outpatient clinic. Cases were defined by the presence of carotid plaque, identified via B-mode Doppler ultrasound, and defined according to international consensus criteria. Controls had no evidence of plaque. We performed multivariate logistic regression to identify independent predictors of atherosclerosis, including hsCRP, lipid parameters, and estimated glomerular filtration rate (eGFR). Results: After multivariable adjustment, three factors emerged as significant, independent predictors of carotid atherosclerosis. High total cholesterol (≥200 mg/dL) was the most powerful predictor, associated with a more than seven-fold increased odds of plaque (Adjusted Odds Ratio [aOR]: 7.38; 95% Confidence Interval [CI]: 2.87–18.94; p<0.001). Elevated hsCRP (≥2 mg/L) (aOR: 3.38; 95% CI: 1.33–8.59; p=0.005) and abnormal eGFR (≤90 mL/min/1.73m²) (aOR: 3.36; 95% CI: 1.10–10.22; p<0.001) were also robustly associated with atherosclerosis, each conferring over a three-fold increase in odds. Conclusion: In this elderly Indonesian study, dyslipidemia remains a dominant risk factor for carotid atherosclerosis. However, systemic inflammation (high hsCRP) and mild renal dysfunction (abnormal eGFR) are also powerful, independent contributors. These findings highlight the multifactorial nature of atherosclerosis and underscore the importance of a comprehensive risk assessment that extends beyond traditional lipid profiling to include markers of inflammation and renal health.

Beyond Cholesterol: The Independent Roles of Inflammation and Renal Dysfunction in Carotid Atherosclerosis Among Indonesian Elders Rukiah Chodilawati; Taufik Indrajaya; Ferry Usnizar; Sudarto; Irsan Saleh
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1386

Background: Atherosclerosis remains a leading cause of mortality in aging populations, driven by a complex interplay of metabolic and inflammatory factors. While dyslipidemia is a cornerstone of risk, the contributions of systemic inflammation, marked by high-sensitivity C-reactive protein (hsCRP), and declining renal function are increasingly recognized. This study aimed to elucidate the independent associations of hsCRP, dyslipidemia, and renal function with the presence of carotid atherosclerosis in an understudied elderly Indonesian population. Methods: We conducted a single-center, case-control study at a tertiary hospital in Palembang, Indonesia, from January to June 2024. One hundred participants aged ≥60 years were enrolled from the geriatric outpatient clinic. Cases were defined by the presence of carotid plaque, identified via B-mode Doppler ultrasound, and defined according to international consensus criteria. Controls had no evidence of plaque. We performed multivariate logistic regression to identify independent predictors of atherosclerosis, including hsCRP, lipid parameters, and estimated glomerular filtration rate (eGFR). Results: After multivariable adjustment, three factors emerged as significant, independent predictors of carotid atherosclerosis. High total cholesterol (≥200 mg/dL) was the most powerful predictor, associated with a more than seven-fold increased odds of plaque (Adjusted Odds Ratio [aOR]: 7.38; 95% Confidence Interval [CI]: 2.87–18.94; p<0.001). Elevated hsCRP (≥2 mg/L) (aOR: 3.38; 95% CI: 1.33–8.59; p=0.005) and abnormal eGFR (≤90 mL/min/1.73m²) (aOR: 3.36; 95% CI: 1.10–10.22; p<0.001) were also robustly associated with atherosclerosis, each conferring over a three-fold increase in odds. Conclusion: In this elderly Indonesian study, dyslipidemia remains a dominant risk factor for carotid atherosclerosis. However, systemic inflammation (high hsCRP) and mild renal dysfunction (abnormal eGFR) are also powerful, independent contributors. These findings highlight the multifactorial nature of atherosclerosis and underscore the importance of a comprehensive risk assessment that extends beyond traditional lipid profiling to include markers of inflammation and renal health.

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