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All Journal Heart Science Journal
Adhika Prastya Wikananda
Universitas Brawijaya
Health Professions Immunology & microbiology Medicine & Pharmacology

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New Paradigm of Complete Revascularization in Acute Coronary Syndrome with Multivessel Coronary Artery Disease: Is it Reasonable in Clinical Practice? Adhika Prastya Wikananda; Mohammad Saifur Rohman; Novi Kurnianingsih; Cholid Tri Tjahjono
Heart Science Journal Vol 2, No 3 (2021): The Science and Art of Myocardial Revascularization
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.03.2

Abstract

Coronary artery disease is the leading cause of illness and death in older adults. Around 40% to 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multiple coronary artery disease. Multiple vessel coronary disease has been shown to improve cardiac outcomes and survival in patients who have undergone complete revascularization (CR) versus patients who have undergone only incomplete revascularization (ICR). When coronary angiography and PCI of the source of the infarction are performed on patients with STEMI, the risk of adverse cardiac death or myocardial infarction is significantly reduced. Additional research is needed to determine the efficacy of PCI of non-critical lesions. However, following procedures such as CABG or PCI, these procedures may be impossible to perform due to a variety of personal, anatomical, technical, and logistical barriers. In this review, we discussed about benefit of complete revascularization in patient acute coronary syndrome (ACS) with multivessel disease and which patient can be performed aggressive revascularization to achieved CR in clinical practice.Keywords: complete revascularization, acute coronary syndrome, percutaneous coronary intervention
Prognostic Value of Residual Syntax Score Combined with Acef Score in Acute Coronary Syndrome Patient After Percutaneus Coronary Intervention in Saiful Anwar Hospital, Malang Adhika Prastya Wikananda; Mohammad Saifur Rohman; Novi Kurnianingsih; Sasmojo Widito; Ardian Rizal
Heart Science Journal Vol 3, No 1 (2022): Assesment and Outcome of Coronary Artery Disease in the Reperfusion Era
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.01.4

Abstract

Background : Percutaneous coronary intervention (PCI) is one of the revascularization options in patients with clinical acute coronary syndrome (ACS) who often have multiple and complex vascular lesions. So, the decision to complete revascularization is still a topic that is widely explored to reduce the rate of rehospitalization and reinfarction. This study aims to determine the predictor value of rehospitalization and reinfarction events that can be used in ACS patients undergoing IKP using coronary angiography parameters with residual SYNTAX scores and clinical parameters using ACEF scores.  Method : The study was cohort prospective with the inclusion criteria being all ACS patients who underwent PCI in RSUD Dr. Saiful Anwar Malang from January 2017 to July 2021. All patients underwent IKP and underwent coronary angiography evaluation after IKP with a residual SYNTAX score (rSS) and divided into categories into rSS≤8 and rSS>8. All patients underwent laboratory examination of serum creatinine and post-PCI echocardiography, and an ACEF score was obtained (ACEF score = age/left ventricular ejection fraction + 1 [if serum creatinine >2 mg/dl]). Research subjects will be followed up for at least 1 year related to the incidence of post-PCI rehospitalization and reinfarction.  Results : From a total sample of 209 patients, it was found that the residual SYNTAX score data had the most significant predictive factor for the occurrence of rehospitalization at 1 year after PCI (OR 6.14 [95% CI, 1.92-1967]). At the value of rSS > 8, (AUC 0.750 [95% CI, 0.682-0.818], p 0.001) has a good predictive value for the occurrence of rehospitalization. However, combining with clinical parameters using the ACEF score provides a better predictive value. This study shows that the combination of rSS>8 and ACEF score>1.2 provides a better predictive value (AUC 0.884 [95%CI, 0.832-0.936) for the incidence of rehospitalization in post-PCI ACS patients. Conclusion : Acute coronary syndrome patients with residual SYNTAX scores > 8 and ACEF scores > 1.2 had a strong predictive value for rehospitalization events 1 year after PCI. The use of the combination of these two scores is expected to be a clinical guide to obtain the degree of completeness of revascularization in ACS patients.
The Role of STEMI Communication Network in Malang with Major Adverse Cardiac Event (MACE) Incidence in STEMI Patients Hospitalized in Saiful Anwar General Hospital Malang Adhika Prastya Wikananda; Lenny Kartika; Dadang Hendrawan; Heny Martini; Mohammad Saifur Rohman
Heart Science Journal Vol 2, No 4 (2021): Management of Thrombosis in Covid-19 Patient with Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.04.3

Abstract

Background: Patient with STEMI requires urgent reperfusion either with fibrinolytic or primary PCI. In Malang, a communication network of STEMI has been developed. It connects Saiful Anwar General Hospital with all of the PHC in Greater Malang to shorten system delay since 2015.Objective: To elucidate Malang’s communication network’s role in decreasing MACE (Major Adverse Cardiac Event) in STEMI patients.Methods : This is a retrospective cohort study. Study sample was taken from medical record. Non-network: 96 patients and 88 network patients. Statistical tests using SPSS and PLS, α value 0.05 and t-test is significant if more than 1.96.Results: Bivariate analysis shows network-group has a significantly lower MACE (p=0.001). Door-to-balloon time is also lower in network-group (p=0.026). Multivariate analysis without confounder shows that network-group has significantly shorter door-to-reperfusion time (p=0.032) and lower MACE (p=0.035) compared to non-network group. But multivariate analysis with confounder door-to-balloon and door-to-needle fails to explain lower MACE incidence. Network-group (p=0.005) and reperfusion with primary PCI (p=0.05) significantly decrease MACE incidence.Conclusion: Malang’s STEMI communication network and reperfusion with primary PCI reduce MACE in STEMI patients in Saiful Anwar General Hospital Malang.
Co-Authors Ardian Rizal Cholid Tri Tjahjono Dadang Hendrawan Heny Martini Lenny Kartika Mohammad Saifur Rohman Novi Kurnianingsih Sasmojo Widito