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All Journal Indonesian Journal of Cardiology ACI (Acta Cardiologia Indonesiana)
Sunanto Ng
Faculty Of Medicine, University Of Pelita Harapan, Jakarta, Indonesia Department Of Cardiology, Siloam Hospital Lippo Village, Indonesia
Health Professions Medicine & Pharmacology

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Implantasi Drug-eluting Stentatas Indikasi Off-label: Pengalaman dan Luaran Klinis di Pusat Jantung Nasional Harapan Kita David D Ariwibowo; Daniel Tobing; Sunanto Ng; Muhammad Munawar; Sunarya A Soerianata
Jurnal Kardiologi Indonesia Vol. 29, No. 2 Mei - Agustus 2008
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v29i2.190

Abstract

Background. Food and Drug Administration (FDA) of Unites States set the indication of drug-eluting stent (DES) on the product label (on-label indication). In the clinical practice, many patients received DES implantation outside the indication (off-label indication). Several “real-world” register showed off-label implantation reach prevalence of 50-60% with wide-ranging clinical outcomes.Objectives. To report the frequency, procedural complications, stent thrombosis (ST) and major cardiovascular events (MACE) of DES implantation with off-label indication in the National Cardiac Center Harapan Kita.Methods. This retrospective cohort study included patients who underwent coronary intervention with one or more DES (sirolimus or paclitaxel) implantation at 2006. Subjects were grouped into on-label and off-label indication. Subjects were followed-up until mid 2008.Results. 196(59%) of total patients who received DES implantation in 2006 in PJNHK are on off-label indications. The most frequent off-label indication was long-lesion intervention. There were more patients with previous myocardial infarction, PCI and CABG in off-label group. No significant difference of procedural complication rates between on-label and off-label group (2.2% vs. 2.6%, P =0.57). There was no significant difference of stent thrombosis rate. There was higher incident of MACE in off-label than on-labelgroup (17.9% vs. 8.6%, P =0.03). This difference was most contributed by incident of cardiac death. The adjusted hazard ratio of off-label was 1.7 (95% CI 0.8 – 3.6; P = 0.16); with several confounding factors including previous cerebrovascular disease, creatinine clearance <60 mL/min, non-elective PCI and double antiplatelet cessation. Conclusion. Off-label indication was quite frequent but has non-significant difference of TVR and ST rate compared to on-label indication. There was higher incident of MACE in off-label group, but this may be influenced by several clinical confounders.
Tantangan Penatalaksanaan STEMI di Pandemi Covid-19 Sunanto Ng; Dafsah Arifa Juzar
Jurnal Kardiologi Indonesia Vol 41 No 2 (2020): Indonesian Journal of Cardiology: April - June 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1023

Abstract

The necessity of timely management of ST-elevation myocardial infarction (STEMI) is now disrupted by the Covid-19 pandemic. This paper discussed the challenge to manage STEMI in Indonesia due to Covid-19. It also discussed the alternative strategies for solution. Challenge can occur in term of the healthcare safety as well as STEMI patient safety. Healthcare safety potentially impaired by the problem of STEMI mimicry due to cardiovascular complication of Covid-10, inaccuracy of Covid-19 screening, lack of effective personal protection equipment for the healthcare and appropriate catheterisation laboratory to anticipate virus contamination. The safety of STEMI patient is potentially impaired due to prolonged ischemia time, and the risk of cross-infection. Solution for this challenge should include mass screening, rapid and accurate test to rule-out Covid-19, dual system of hospital units - Covid and non-Covid, and algorithm for triage patients with STEMI and Covid-19.
Menulis Pandemi Sunanto Ng
Jurnal Kardiologi Indonesia Vol 41 No 2 (2020): Indonesian Journal of Cardiology: April - June 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1026

Abstract

Dunia saat ini menghadapi situasi yang tidak pernah terjadi sebelumnya dalam sejarah manusia: pandemi Covid-19 (Gambar). Pengetahuan manusia mengenai penyakit Covid-19 secara pesat berkembang sejak laporan kasus awal dari Wuhan.1 Secara pesat, banyak laporan kasus, seri kasus, kohor dan belakangan studi mengenai Covid-19 dan tatalaksananya dilaporkan di berbagai jurnal. Beberapa jurnal esensial, seperti NEJM dan Lancet, bahkan menerbitkan isu khusus mengenai Covid-19. Pengetahuan tentang Covid-19 secara mayor boleh dikatakan berasal dari tiga klaster kohor epidemi; yaitu di China (terutama Wuhan), Italia, dan Amerika Serikat. Beberapa klaster lainnya, seperti dari Korea Selatan dan Jerman, melaporkan keberhasilan meredam perluasan epidemi.
Acute Changes on Pulmonary Pressure Following Percutaneous Closure of Secundum Atrial Septal Defect Jessica Wiryanto; Ingrid M. Pardede; Sunanto Ng
ACI (Acta Cardiologia Indonesiana) Vol 3, No 2 (2017)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.33553

Abstract

Pulmonary hypertension is a common complication of congenital heart disease due to systemic – pulmonary circulation shunt which if left uncorrected leads to increased pulmonary artery pressure, vascular remodeling and further increase of pulmonary vascular resistance. Percutaneous closure of the defect interrupts this shunt thus reducing right heart and pulmonary circulation load and pulmonary artery pressure. In this paper we present two cases of percutaneous secundum atrial septal defect closure complicated by pulmonary hypertension along with echocardiographic evaluation of cardiopulmonary hemodynamic changes before and shortly after device closure. Forty years old and thirty three years old females presented to our clinics with classical symptoms of atrial septal defects, assessment revealed TVG of 37 mmHg and 30 mmHg,shortly after the procedure patient was re-evaluated and revealed TVG of 39 mmHg and 23 mmHg respectively. From these cases we conclude that changes in pulmonary artery pressure is not constantly found after device closure. However both patients display improvements in functional capabilities.
Consensus Statements on the Use of High-Sensitivity Troponin I as the Assessment of Cardiac Risk in Apparently Healthy Population in Indonesia Ambari, Ade Meidian; Ng, Sunanto; Rejeki, Vidya Gilang; Rina Artha, I Made Junior; Raynaldo, Abdul Halim; Alsagaff, Mochamad Yusuf; Wicaksono, Sony Hilal; Dwiputra, Bambang; Desandri, Dwita Rian
Jurnal Kardiologi Indonesia Vol 44 No 3 (2023): Indonesian Journal of Cardiology: July - September 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1544

Abstract

Cardiovascular disease (CVD) is a growing burden in Indonesia, making primary prevention of utmost importance. High sensitivity cardiac troponin I (hsTnI) has been known as one of the biomarkers of choice for diagnosing acute myocardial infarction. Nonetheless, recent studies indicate that hsTnI assay has potential as a predictor of cardiac risk in asymptomatic individuals. An advisory board consisting of renowned cardiologists from the Indonesian Heart Association was convened in Jakarta in March 2023. The meeting aimed to explore the appropriate use of hsTnI for cardiovascular (CV) risk stratification in apparently healthy adults in Indonesia. The board reviewed relevant literature and developed key consensus statements, including hsTnI cut-off for identifying high-risk asymptomatic patients, the proposed algorithm, and monitoring after aggressive risk factor control. This article presents the resulting consensus statements to provide clinicians with a practical tool for planning primary prevention strategies. Furthermore, it is expected to raise awareness and advocacy among stakeholders in the healthcare infrastructure regarding the use of hsTnI as a guide for assessing CV risk in Indonesia.
Dyslipidemia management among patients with high and very high cardiovascular risk in Indonesia: a multi-center registry Ng, Sunanto; Santoso, Anwar; Sukmawan, Renan; Erwinanto, Erwinanto; Adam, Erika; Desandri, Dwita Rian; Zahra, Rita; Wicaksono, Sony Hilal; Putra, Magma Purnawan; Heriansyah, Teuku; Tiksnadi, Badai Bhatara; Pintaningrum, Yusra
Jurnal Kardiologi Indonesia Vol 46 No 2 (2025): April - June, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1880

Abstract

Background Indonesia, the world's largest archipelago, faces significant challenges in equitable healthcare delivery due to its geographical and infrastructural disparities. Atherosclerotic Cardiovascular Disease (ASCVD) remains the leading cause of mortality, with over 659,000 deaths recorded in 2019. Effective dyslipidemia management is crucial for preventing adverse ASCVD events. Unfortunately, the lack of implementation of an updated national lipid management registry might hinder optimal strategy for the adverse events. This study evaluated dyslipidemia cholesterol management practices among high- and very high-risk patients across the country. Methods The study recruited 322 patients from eight centers across six provinces in Indonesia between May 2022 and March 2023. Patients were stratified based on the ASCVD risk and followed over three visits. Baseline clinical characteristics, lipid profiles, and treatment regimens were analyzed. Descriptive statistics summarized continuous and categorical variables, and low-density lipoprotein cholesterol (LDL-C) achievement was assessed. Results Of the 322 patients, 98.8% were very high-risk, with only 4.9% achieving <55 mg/dL and 21.2% achieving <70 mg/dL. Moderate-intensity statins were the most prescribed (51.2%), followed by high-intensity (36.6%). LDL-C reduction was most pronounced in private insurance patients, achieving a mean LDL-C of 69.8 mg/dL at the third visit compared to 98.9 mg/dL in National Health Insurance (Jaminan Kesehatan Nasional/JKN) participants. Missed visit rates increased over time, with 57.5% of patients missing the third visit, predominantly among JKN participants and low-income groups. Conclusion Majority of the population failed to achieve the recommended target of LDL-C levels. Dyslipidemia management in Indonesia remains suboptimal, with disparities driven by socioeconomic factors. Improved policies addressing medication availability, national lipid registry establishment, and equitable healthcare access are essential to enhance lipid management and reduce the burden of ASCVD in Indonesia.
Co-Authors Adam, Erika Alsagaff, Mochamad Yusuf Ambari, Ade Meidian Anwar Santoso Badai Bhatara Tiksnadi Daniel Tobing David D Ariwibowo Desandri, Dwita Rian Dwiputra, Bambang Erwinanto, Erwinanto Ingrid M. Pardede Jessica Wiryanto Juzar, Dafsah Arifa Muhammad Munawar Pintaningrum, Yusra Putra, Magma Purnawan Raynaldo, Abdul Halim Rejeki, Vidya Gilang Renan Sukmawan Rina Artha, I Made Junior Sunarya A Soerianata Teuku Heriansyah, Teuku Wicaksono, Sony Hilal ZAHRA, RITA