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Myocardial Bridging: Tinjauan Mendalam Mengenai Anomali Koroner Nurudinulloh, Akhmad Isna; Widito, Sasmojo
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.

Tinjauan Mendalam Pengaruh Insufisiensi Renal terhadap Major Adverse Car- diovascular Event (MACE) dan Mortalitas pada Pasien Infark Miokard Akut Ele- vasi Segmen St (IMA-EST) Nurudinulloh, Akhmad Isna; Anjarwani, Setyasih
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.6

The widespread implementation of invasive procedures such as coronary angiography and primary percutaneous coronary intervention (PCI) into the routine management of patients with acute ST-segment elevation myocardial infarction (STEMI) in the last 10 years has led to a significant improvement in patient prognosis. At the same time, this also raises new problems and questions, mostly related to the fact that there are many elderly patients and/or patients with comorbidities who need to undergo this invasive procedure. One of the most important comorbidities is renal insufficiency. STEMI patients with renal insufficiency typically present with more extensive atherosclerotic lesions, including diffuse coronary calcification, which poses a challenge to the interventional cardiologist due to a higher risk of periprocedural complications, higher risk of restenosis, major adverse cardiovascular event (MACE) , and patient mortality. This review discusses in depth the influence of renal insufficiency on MACE and mortality in STEMI patients. Keywords: renal insufficiency, STEMI, MACE, mortality.

Unveiling strategies in acute cardiac care for ventricular septal rupture following acute myocardial infarction: Lessons from cases Nurudinulloh, Akhmad Isna; Anjarwani, Setyasih; Prasetya, Indra; Yogibuana, Valerinna; Rahimah, Anna Fuji; Karolina, Wella
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.2025.006.02.17

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is drastically decreasing in the reperfusion era but mortality remains high. VSR correction is the definitive treatment and using mechanical support to delay closure is an attractive option despite data on success being limited. Case Illustration: A 60-year-old man presented with late presentation of anterior STEMI complicating hemodynamic deterioration. Echocardiography showed apical VSR 11-14 mm L-R shunt. Patient was given adequate fluids, multiple inotropic agents, and IABP insertion, then a successful PPCI procedure was performed immediately. IABP was maintained for hemodynamic stabilization and patient was scheduled for interventional closure. Unfortunately, the patient worsened due to cardiogenic shock and passed away on the 5th day of admission. In another case, a 61-year-old man came to our hospital also with a late presentation of anterior STEMI but stable in hemodynamics. Echocardiography showed apical VSR 9-11 mm L-R shunt. Coronary angiography showed CAD three vessel disease with critical stenosis at LAD. In hospital’s heart team discussion, patient was planned to be performed VSR closure percutaneously and continue with PCI procedure. Both procedures were performed successfully. Patient was improved and discharged on 20th day of admission. Conclusion: Rapid diagnosis and prompt treatment are the keys to optimal management of VSR complicating late presentation STEMI. Mechanical circulatory support and correction of VSR are required to optimize patient outcomes despite VSR is still a challenging case.

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.

Tinjauan Mendalam Pengaruh Insufisiensi Renal terhadap Major Adverse Car- diovascular Event (MACE) dan Mortalitas pada Pasien Infark Miokard Akut Ele- vasi Segmen St (IMA-EST) Anjarwani, Setyasih; Nurudinulloh, Akhmad Isna
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.6

The widespread implementation of invasive procedures such as coronary angiography and primary percutaneous coronary intervention (PCI) into the routine management of patients with acute ST-segment elevation myocardial infarction (STEMI) in the last 10 years has led to a significant improvement in patient prognosis. At the same time, this also raises new problems and questions, mostly related to the fact that there are many elderly patients and/or patients with comorbidities who need to undergo this invasive procedure. One of the most important comorbidities is renal insufficiency. STEMI patients with renal insufficiency typically present with more extensive atherosclerotic lesions, including diffuse coronary calcification, which poses a challenge to the interventional cardiologist due to a higher risk of periprocedural complications, higher risk of restenosis, major adverse cardiovascular event (MACE) , and patient mortality. This review discusses in depth the influence of renal insufficiency on MACE and mortality in STEMI patients. Keywords: renal insufficiency, STEMI, MACE, mortality.

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