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All Journal Journal of Biomedicine and Translational Research Indonesian Journal of Cardiology Medica Hospitalia
Herry, Yan
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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Association between Neutrophil to Lymphocyte Ratio and Post Operative Atrial Fibrillation after Coronary Artery Bypass Graft operation. Sidiek, Aboesina; Herry, Yan; Ardhianto, Pipin; Bahrudin, Udin
Journal of Biomedicine and Translational Research Vol 10, No 1 (2024): April 2024
Publisher : Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v10i1.20804

Abstract

ABSTRACT Background: Post operative atrial fibrillation (POAF) is associated with cardiovascular outcomes such as stroke, heart failure, and mortality. Neutrophil to lymphocyte ratio (NLR) is one of biomarker of inflammation. The use of cor pulmonary bypass(CPB), surgical trauma and reperfusion injury during cardiac surgery causes inflammation. NLR is suspected to be a biomarker that represents the inflammatory response as a modulator of POAF, but data are still lacking.This study analyzed the association between NLR and POAF after coronary artery bypass graft (CABG) operation.Methods: This was an Observational analytic study, involving patients after the CABG procedure in Kariadi Hospital between June 2022 to September 2023. NLR was assessed in the first three hours after operation. ECG Holter was attained for 96 hours post-CABG procedure.Results: The total subject was 62 patients, consisting of 57 men and 5 women with a mean age of 58,7 ± 6.39 years. Mean postoperative NLR 4.95 ± 2.17 with a median of 4.56 (1.52-11.00). There was a significant association between post-operative NLR with POAF after CABG (p=0.006, OR 4.64, 95%CI 1.50-14.35). High inotropic dose and β blocker initiation time less than 45 hours correlate significantly with POAF after CABG (p<0.001, OR 6.94 dan p=0.001, OR 0.17).Conclusions: Postoperative NLR is associated significantly with POAF after CABG. Keywords: Neutrophil to Lymphocyte Ratio, Post Operative Atrial Fibrillation, coronary artery bypass graft, ECG Holter
External Validation of Major Adverse Cardiovascular Events’ Predictors in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Raharjo, Robert Adrianto; Herminingsih, Susi; Ardhianto, Pipin; Herry, Yan
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (602.671 KB) | DOI: 10.36408/mhjcm.v8i2.569

Abstract

BACKGROUND: KARIADI risk score is a 0-to-9 point system based on Killip class, final TIMI flow, total ischemic time, creatinine level, blood glucose, systolic blood pressure, and age. This score was developed to predict the risk of in-hospital major adverse cardiovascular events (MACE) (a composite of death, stroke, urgent revascularization, cardiogenic shock, acute pulmonary edema, or arrhythmia) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI), but its performance has never been validated externally. OBJECTIVE: To perform external validation on KARIADI risk score. METHOD: This study was a prospective cohort study on 109 STEMI patients undergoing PPCI in Dr. Kariadi General Hospital during January-November 2020. Each sample underwent KARIADI risk score assessment and follow-up for in-hospital MACE. The risk score validation was performed by assessing calibration [measured with calibration-in-the-large (alpha), calibration slope (beta), and calibration plot] and discrimination performance [measured with c-statistic and receiver operating characteristic curve). RESULT: Eighteen patients (16.5%) had MACE. KARIADI risk score demonstrated unsuitable calibration (alpha -0.39, beta 0.71, unfit calibration plot) and moderate discrimination performance (c-statistic 0.75, 95% CI 0.62-0.87). CONCLUSION: KARIADI risk score is not valid in predicting in-hospital MACE in patients with STEMI undergoing PPCI. Keywords: ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, KARIADI risk score, external validation
Pengembangan Skor Risiko KARIADI Sebagai Metode Stratifikasi Risiko Kejadian Kardiovaskular Mayor Pasca Intervensi Koroner Perkutan Primer Asrial, An Aldia; Herry, Yan; Udin, Bahrudin; Anggriyani, Novi; Suhartono, Suhartono
Medica Hospitalia : Journal of Clinical Medicine Vol. 9 No. 1 (2022): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (352.157 KB) | DOI: 10.36408/mhjcm.v9i1.640

Abstract

Background Reduction of major cardiovascular events (MACE) in ST elevation acute coronary syndrome (STE-ACS) patients has been achieved by primary percutaneous coronary intervention (PCI) strategy and intensive care management. However, the intensive care unit bed availability and cost remain a problem for those patients, and thus risk stratification using an objective risk score instrument is required. Aim To develop a risk score of in-hospital MACE for patients with STE-ACS underwent primary PCI. Methods A cohort study of 208 patients with STE-ACS undergoing primary PCI at the Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using bivariate Chi-Square test and multivariate logistic regression. The obtained independent predictors were then used as risk score variables. The quality of the risk score was tested by the Hosmer and Lemeshow calibration test and AUC ROC analysis for discrimination test. Results Seven out of 13 independent predictors, i.e. Killip class (OR 20,04, p=0,0001), age (OR 3,02, p=0,04), renal insufficiency (OR 9,48, p=0,007), infark related artery final TIMI flow (OR 11,57, p=0,001), admission systolic blood pressure (OR 3,04, p=0,025), duration of total ischaemic time (OR 3,14,p=0,032) and increase of blood glucose levels (OR 3,04, p=0,029) were fulfilled the criteria for risk scores of in-hospital MACE. The risk scores had a good quality with the Hosmer and Lemeshow calibration test> 0,05 and ROC AUC 0,886 (95% CI, 0,827-0,944, p <0,005). Conclusions A risk scoring modele consisting of 7 independent predictor variables i.e. Killip class, age, renal insufficiency, infark related artery final TIMI flow, admission systolic blood pressure, duration of total ischaemic time, and increase of blood glucose levels (KARIADI) has a good calibration and discrimination in predicting the risk of in-hospital MACE in patients with STE-ACS underwent primary PCI. Keywords Predictors of in-hospital MACE, primary PCI, ST-segment elevation acute coronary syndromes, risk score.
Kejadian Kardiovaskular Mayor di Rumah Sakit pada Pasien STEMI di Era Pandemi COVID-19 Mangkoesoebroto, Arjatya Pramadita; Herry, Yan; Sofia, Sefri Noventi; Bahrudin, Udin
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 1 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i1.852

Abstract

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has become a global burden, changing healthcare system and affecting patients with ST segment elevation myocardial infarction (STEMI). Several countries reported a decrease in hospital admission, changing management, increase total ischemic time, and major cardiovascular events (MACE) in the pandemic era. However, there is limited data especially in Indonesia. OBJECTIVE: To know the differences in admissions, characteristics, management and in-hospital MACE in STEMI patients between pre and pandemic era. METHODS: Comparative observational analytical study was done on 169 patients in the pre-pandemic (12 March 2019-11 March 2020) compared to 163 patients in the pandemic era (12 March 2020-30 September 2021) with STEMI at dr. Kariadi Semarang Hospital. Assessment of monthly admission rates, total ischaemic time, reperfusion management, COVID-19 status and MACE were carried out. RESULTS: During the COVID-19 pandemic, there was a decrease in the average admission of 14.1 to 8.6 patients per month (p<0.001), increase total ischaemic time of 8.78 (3.22-19.68) hours to 10.22 (3 .20-20.43) hours (p<0.001), decreased use of primary PCI (97.0% vs. 83.4%, p<0.001), increased fibrinolytic (1.8% vs8.6%,p=0.010) and no reperfusion (1.2%vs8.0%, p=0.007). There was a significant increase in MACE in the era of the COVID-19 pandemic (10.7%vs22.1%,p=0.008), with mortality (4.7%vs11.7%,p=0.035), stroke (1.2%vs1.8%,p=0.680), cardiogenic shock (4.1%vs11.0%, p=0.030), and acute pulmonary edema (3.6%vs10.4%,p=0.024). CONCLUSION: There was a decrease in admissions and primary PCI procedure, increase use of fibrinolytics and without reperfusion, total ischemic time prolongation, and significant increase of in-hospital MACE in STEMI patients during the COVID-19 pandemic.
inggris Asrial, An Aldia; Pudjiastuti, Anggit; Herry, Yan; Bahrudin, Udin
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.1324

Abstract

Background Zwolle, TIMI, and GRACE risk scores have been proven to predict mayor adverse cardiovascular events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). However, they were developed over a long time ago which many advances have been made in the cardiovascular field today. The scores were also developed in the non-Asian majority population and their accuracy for Indonesian population remains unknown. We aimed to validate and compare these scores for Indonesian population. Methods An analytical observational study was conducted on 193 patients undergoing primary PCI. The Zwolle, GRACE, and TIMI risk scores were calculated for each patient. Then, the risk score validation was carried out with the calibration test using Hosmer Lemeshow test and discrimination test using the AUC ROC. Furthermore, the comparisons between the risk scores were carried out using the DeLong test. Results The three scores have good results in the Hosmer Lemeshow calibration test (p > 0.05). The discrimination test also indicated good results with AUC ROC Zwolle, TIMI and GRACE risk scores respectively 0.776; 0.782; 0.831 (p<0.05). There was no significant difference in the prediction accuracy of the three risk scores in the DeLong test. Conclusions The Zwolle, TIMI, and GRACE risk scores had good validity for predicting major adverse cardiovascular events in STEMI patients undergoing primary PCI. There was no significant difference in the prediction accuracy of the three risk scores. Keywords: Risk score, major adverse cardiovascular events, primary percutaneous coronary interventions
Co-Authors AA Sudharmawan, AA ABOESINA SIDIEK Asrial, An Aldia Herminingsih, Susi Mangkoesoebroto, Arjatya Pramadita NOVI ANGGRIYANI, NOVI Pipin Ardhianto, Pipin Pudjiastuti, Anggit Raharjo, Robert Adrianto Sefri Noventi Sofia Udin Bahrudin, Udin Udin, Bahrudin