Sitepu, Andika
Departemen Jantung Dan Pembuluh Darah, Fakultas Kedokteran Universitas Sumatera Utara

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Adherence to European Society of Cardiology Heart Failure Treatment Guideline in Haji Adam Malik General Hospital Medan Wirtanto, Ardy Putra; Sitepu, Andika
Sumatera Medical Journal Vol. 3 No. 1 (2020): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v3i1.3382

Abstract

Background. Heart failure is a public health problem and the main cause of morbidity and mortality in the world. The goal of the therapy is to reduce symptoms, prevents rehospitalization and increases survivability. Objective. To evaluate the adherence to the European Society of Cardiology for heart failure treatment at H. Adam Malik Medan hospital. Methods. The study was descriptive observational cross sectional design with medical record data of heart failure at H. Adam Malik Hospital, using consecutive sampling method. The adherence of guidelines was assessed by: (1) drug prescribing (“yes” or “no”), and (2) guideline adherence indicator (GAI), both GAI-3 or GAI-5, by calculating the proportion as the number of drugs prescribed by number of drugs indicated to the ESC guidelines. Results. From research, the predominant GAI-3 and GAI-5 were High, which were 54.9% and 59.5%, respectively. The recommended drug used based on indications were ACE-i / ARB (89.1%), beta-blockers (83.4%), MRA (73.6%), diuretics (93.7%), and digitalis (20,8%). Conclusion. The predominant category in adherence to the ESC heart failure treatment guidelines based on GAI-3 and GAI-5 is High.
Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy Aldino Satria Adhitya; Andika Sitepu; Zulfikri Mukhtar; Harris Hasan
Jurnal Kardiologi Indonesia Vol 39 No 2 (2018): Indonesian Journal of Cardiology: April-June 2018
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v39i2.735

Abstract

Background: ST Elevation Myocardial Infarction (STEMI) may cause Major Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI patients to restore coronary blood flow, hence saving myocardial perfusion. ST Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in STSD. Methods: This cohort prospective study with 60 subjects of STEMI patients which are evaluated for MACE (death, heart failure, and rehospitalization) within 30 days after myocardial infarction. Resolution in STSD is defined as resolution ≥ 50% STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8,32 (2,11-32,74), p=0,001; smoking with OR 4,17 (1,05-16,57), p=0,034; Anterior STEMI with OR 3,94 (1,11-13,90), p= 0,027; Creatinine > 1,97 mg/dl with OR 3,69 (1,18-11,55), p= 0,022; complete outpatient medication with OR 5,23 (1,61-17,01), p= 0,004; fragmented QRS with OR 5,23 (1,61-17,01), p= 0,001; resolution in STSD with OR 26,35 (5,16-134, 40), p=<0,001; resolution in ST Segment Elevation with OR 10,5 (2,97-37,24), p=<0,001; are proven to be determining factor for MACE within 30 days. Multivariate analysis showed that among those determining factors for MACE, resolution in STSD on reciprocal leads is evidently the most dominant factor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy [OR 11.47 (1.14-115.10), p=0.038].Conclusion: There is significant difference in MACE within 30 days after myocardial infarction (MI) between patients with and without resolution in STSD. The subjects without resolution in STSD showed higher MACE incidence. Resolution in STSD is evidently an independent predictor for MACE within 30 days after myocardial infarction in STEMI patients.Keywords: Resolution in STSD, MACE, STEMI, Fibrinolytic
Precordial ST Segment Depression on Admission Electrocardiogram as a Simple Noninvasive Tool for Predicting Coronary Artery Disease Complexity in Patients with Inferior Myocardial Infarction Jaya Suganti; Anggia Chairuddin Lubis; Abdullah Afif Siregar; Andika Sitepu; Cut Aryfa Andra; Ali Nafiah Nasution; Harris Hasan
Jurnal Kardiologi Indonesia Vol 40 No 4 (2019): Indonesian Journal of Cardiology: October-December 2019
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v40i4.849

Abstract

Precordial ST Segment Depression on Admission Electrocardiogram as a Simple Noninvasive Tool for Predicting Coronary Artery Disease Complexity in Patients with Inferior Myocardial Infarction Jaya Suganti, Anggia Chairuddin Lubis, Abdullah Afif Siregar, Andika Sitepu, Cut Aryfa Andra, Ali Nafiah Nasution, Harris Hasan Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia Background: Whether a precordial ST segment depression (PSTD) is merely a benign electrical phenomena or a sign of multivessel coronary artery disease (MVCAD) in inferior myocardial infarction (MI) remains unclear. The objective of this study is to analyze the complexity of coronary artery disease (CAD) in inferior MI patients with PSTD and to investigate whether PSTD can be used as a predictor of MVCAD in inferior MI. Methods: Patients with inferior MI were divided into two groups based on the presence of PSTD on admission ECG and were compared based on the patient’s coronary artery complexities. Results: A total of 215 patients with inferior MI were found in this study period, with 102 patients meet the inclusion and exclusion criteria. Patients with PSTD had a higher incidence of MVCAD and SYNTAX score. Further analyzes showed PSTD on admission ECG was an independent predictor of MVCAD in inferior MI [45 (66%) vs 23 (34%); OR 4.097; 95% CI 1.638-10.247; p=0.003). Conclusion: In daily clinical practice, PSTD on admission ECG may serve as a simple noninvasive tool for predicting MVCAD or a more complex CAD in inferior MI. Keywords: Precordial ST Segment depression, inferior myocardial infarction, SYNTAX score
PREDICTORS OF IN-HOSPITAL LENGTH OF STAY IN NSTEMI PATIENTS Ahmad Handayani; Andika Sitepu; Faisal Habib
Buletin Farmatera Vol 4, No 3 (2019)
Publisher : Universitas Muhammadiyah Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (734.521 KB) | DOI: 10.30596/bf.v4i3.2156

Abstract

As our population grows older, the rate of NSTEMI patients is rising. Risk stratification is an important process for patients with Non-ST Elevation Myocardial Infarction (NSTEMI). Global Registry of Acute Coronary Events (GRACE) scores in the best to predict mortality and myocardial infarction in NSTEMI Patients. On the other hand, NSTEMI Patients trends to be older with more co-morbidity. In this scenario, we need to predict the length of stay as it correlates with the patient's prognostic and cost. This study aims to analyze factors influencing the in-hospital length of stay in survivor NSTEMI Patients in four different hospitals (Adam Malik Medan National General Hospital, Pirngadi Medan General Hospital, Grandmed Lubuk Pakam General Hospital, and Aceh Tamiang Public General Hospital). This was an observational study with prospective design conducted on 44 patients in four different hospitals from March to May 2017. We only included the patients that discharged alive from the. hospital Statistical analysis was performed to assess the routine clinical and laboratory variables relations with the length of stay. Prolong length of stay was defined as more than 5 days. As mentioned in the previous study, older age, heart failure will prolong the length of stay. The limitations of this study were we didn't analyze the effect of revascularization, the co-morbidities, and the method of patient’s payment. We should use GRACE and TIMI risk score routinely, optimizing therapy for heart failure and giving special attention to elderly patients in NSTEMI Patients.Keywords: NSTEMI, GRACE, Length of Stay
A Suspected COVID-19-associated Myocarditis Case Mimicking Life-threatening STEMI: a Shark Fin Appearance Ratna Mariana Tamba; Andika Sitepu
Cardiovascular and Cardiometabolic Journal Vol. 2 No. 1 (2021): Cardiovascular and Cardiometabolic Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ccj.v2i1.2021.23-29

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Some cases of myocarditis have been reported associated to Covid-19. The presence of proinflammatory response from immune cells suggested occurs by binding to membrane protein ACE-2 leading to myocardial damage. Our hospital got a refferal from a non-PCI-capable hospital with a 51-years-old woman chest pain and progressive heavy breath with history of fever two days ago. She was diagnosed with anterior STEMI and cardiogenic shock on vassopressors. Her electrocardiogram showed shark fin appearance suggesting life-threatening STEMI. Her rapid test for covid-19 are non-reactive for both IgM and IgG. Her NCCT-thorax showed ground glass opacity in both lungs. Her laboratories finding showed elevated inflammatory markers and elevated cardiac biomarker. We took her naso-oro-pharingeal swab in the same day and process her with emergency PCI. Surprisingly, her angiography showed normal coronary artery without any significant stenosis. From There was no SARS-CoV-2 detected. In myocarditis, patient can mimick the same symptoms as STEMI such as chest pain and heavy breath with elevated cardiac biomarker, but the electrocardiogram usually shows widespread concave ST-elevation with PR-segment depression. Shark fin appearance is usually seen in life-threatening STEMI. In our patient, the NCCT-thorax showed GGO suggested Covid-19 involvement. But, the first swab was negative for SARS-CoV-2. Unfortunately, the patient was discharged without doctor’s consent, so we can not process the second swab and echocardiography to evaluate the function of myocardium. We still can not confirmed this case if it is true myocarditis-associated covid-19 and how was the involvement of the myocardium creating a shark fin mimicking life-threatening STEMI.
Correlation of Platelet-Lymphocyte Ratio (PLR) and Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention (PCI) Steven Winardi; Andika Sitepu
Sumatera Medical Journal Vol. 4 No. 2 (2021): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v4i2.5836

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Acute Coronary Syndrome (ACS) is a series of clinical disorders caused by acute ischemic heart disease. The clinical spectrum of ACS is unstable angina pectoris (UAP), non ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Inflammation occurs from the early stages of atheroma formation to plaque rupture and thrombosis. Thrombocytosis and lymphopenia are associated with the degree of systemic inflammation and the platelet lymphocyte ratio (PLR) is a new marker involving both hematological indices. ST segment elevation myocardial infarction is a type of acute myocardial infarction with high mortality. Management of STEMI patients is carried out with reperfusion therapy consisting of primary percutaneous coronary intervention (PCI) and fibrinolytics. Contrast-induced nephropathy is a serious complication of angiograph procedures that results from administration of contrast media.
The Relationship between Transient Ischemic Dilation (TID) and Severity of Coronary Artery Disease (CAD) in Patients with Chronic Coronary Syndrome (CCS) in Haji Adam Malik Medan, Indonesia Tamba, Ratna Mariana; Lubis, Hilfan Ade Putra; Mukhtar, Zulfikri; Sitepu, Andika; Habib, Faisal; Andra, Cut Aryfa; Haykal, T. Bob
Journal of Society Medicine Vol. 2 No. 9 (2023): September
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i9.88

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Introduction: TID ratio derived from ratio of LV volume in stress and rest phase of MPS. It is said that this phenomenon has been a useful marker of severe CAD, that can be present with atypical angina. This occurs due to global myocardial hypoperfusion caused by severe and extensive CAD. Method: This study was an analytic observational study with a retrospective cohort design in CCS patients who underwent Myocardial Perfusion SPECT at Haji Adam Malik General Hospital from January 2022 to April 2023.  All participants underwent MPS with Tc99m sestamibi with pharmacology Adenosine stress test and coronary angiography. The MPS could be performed before or after coronary angiography without any revascularization procedure between the two examination preocedures. An unpaired t-test analysis was performed to find the mean difference in TID values in the mild CAD and moderate-severe CAD groups. Results: The study subjects totaled 93 people with an average age of 55.87±7.44. It was found that the TID value was significantly different between the two groups of mild and moderate-severe CAD based on Syntax score, 0.906±0.13 vs 1.03±0.11 in the mild vs moderate-severe CAD group (p<0.001). Bivariate analysis showed that in this study, the ratio of TID was only associate with LV ESV and LV EDV in stress phase of MPS (p = 0.001). Conclusion: There is a relationship between TID and CAD severity based on Syntax score with higher TID values in patients with moderate-severe CAD compared to patients with mild CAD. TID ratio was only depends on severity od CAD and directly proportional to the volume of LV in the stress phase, suitable to the theory that said TID ratio comes from ratio of LV volume in stress and rest phase of MPS.
Association between Systemic Inflammatory Immunity Index and Intracoronary Thrombus Burden in Acute Myocardial Infarction with ST Segment Elevation (IMA EST) Patients Undergoing Primary Percutaneous Coronary Intervention at Haji Adam Malik Hospital Dhilion, Har Rawishwar Singh; Nasution, Ali Nafiah; Sitepu, Andika
Journal of Society Medicine Vol. 3 No. 2 (2024): February
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i2.122

Abstract

Introduction: Acute coronary syndrome (ACS) account for 30% of deaths worldwide. High peri-procedural intracoronary thrombus burden is a strong predictor of poor outcome. Inflammation plays an important role in the pathogenesis of intracoronary thrombus formation. The systemic inflammatory immunity index represents the immune responses to inflammation, which consist of neutrophilia, thrombosis and decreased lymphocytes. The previous study showed that systemic inflammatory immunity index predicted high intracoronary thrombus burden in STEMI patients. This study aimed to evaluate systemic inflammatory immunity index in predicting the incidence of high intracoronary thrombus burden in STEMI patients. Method: This research is a retrospective analytical observational study on 95 patients diagnosed with ACS in the period 1 January 2022-31 March 2023 at H. Adam Malik General Hospital, Medan. All patients involved had undergone primary percutaneous coronary intervention. Patient characteristics, risk factors, laboratory results and coronary angiography were recorded from the patient's medical record. Results: There was a significant relationship between the systemic inflammatory immunity index value and the incidence of high intracoronary thrombus burden in STEMI patients (P < 0.001). The systemic inflammatory immunity index cut off point value > 1108 has a sensitivity of 89.4% and a specificity of 89.7% which has a better accuracy in predicting high intracoronary thrombus burden in STEMI patients. Conclusion: Systemic inflammatory immunity index has a good accuracy to predict high intracoronary thrombus burden in STEMI patients.
Comparison of Syntax II Score And Grace Score As Predictors of Major Cardiovascular Events 30 Days after Treatment in STEMI Undergoing PPCI Abimanyu, Roni; Sitepu, Andika; Nasution, Ali Nafiah
Journal of Society Medicine Vol. 3 No. 6 (2024): June
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i6.150

Abstract

Introduction: IMA-EST is still the main cause of morbidity and mortality in Coronary Artery Disease (CAD) and PPCI is still the main treatment method for IMA-EST patients. Even though PPCI has been undergone, patients are reported to still experience mortality and morbidity both in hospital and after discharged. The SYNTAX II score uses clinical, laboratory and anatomical parameters that are believed to be better than the GRACE score to predict mortality and morbidity. Method: This study is an observational analytic with a retrospective cohort design in STEMI patients who underwent PPCI at HAM General Hospital from January 2023 to June 2023. Patients who were diagnosed with STEMI and underwent with PPCI had their GRACE score and SYNTAX II score calculated and followed for 30 days. SYNTAX-II Score’s cut-off point, sensitivity and specificity as well as predictive possibilities in predicting adverse outcomes were determined. Then bivariate analysis was carried out on each SYNTAX-II Score and GRACE score. Results: The study subjects totaled 73 people with an average age of 56.05 ± 10.07 years. The incidence of MACE 30 days after treatment in our sample was 23.3%. It was found that the SYNTAX II score could well predict occurrence of MACE 30 days after treatment (cut off 33,75, AUC 0.861; 0.773 – 0.949; sensitivity 94.1%; specificity 69.6%, PPV 94.1% and NPV 67.6). The result of the bivariate analysis of the SYNTAX-II Score were: P < 0,0001; OR: 18,353; 95%; CI: 2,566 – 131,241and the results of the GRACE Score were: P < 0,006; OR 5,854; 95%; CI: 1,442 – 23,764. Conclusion: The SYNTAX II score is better to predict occurrence of MACE 30 days after treatment in STEMI patients who  undergoing PPCI compared to the GRACE score.
The Relationship between Red Blood Cell Distribution Width and Coronary Artery Lesion Severity In Acute Myocardial Infarction Patients with Non-Elevation of ST-Segment (IMA-NEST) at Haji Adam Malik Hospital Alfuadi, T. Rifki Mirza; Mukhtar, Zulfikri; Sitepu, Andika
Journal of Society Medicine Vol. 3 No. 7 (2024): July
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i7.157

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Introduction: Red cell distribution width (RDW), a measure of erythrocyte size variability, is associated with acute inflammation. Elevated RDW predicts adverse outcomes in cardiovascular diseases like acute myocardial infarction. This study investigated the relationship between RDW and coronary lesion severity, assessed by the SYNTAX Score, in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing coronary angiography. Methods: This retrospective analytical study included NSTE-ACS patients who underwent coronary angiography at H. Adam Malik General Hospital Medan. Baseline characteristics, laboratory parameters (including RDW), and angiography results were collected. The association between RDW and SYNTAX Score was analyzed. ROC/AUC curve analysis assessed RDW's predictive ability for coronary lesion severity, determining sensitivity and specificity. Results: In 160 patients, RDW was significantly associated with SYNTAX Score (p<0.001). TIMI score, GRACE score, and number of involved arteries also correlated with lesion severity. Conclusion: RDW is a promising predictor of coronary lesion severity in NSTE-ACS patients undergoing coronary angiography.