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NOVI ANGGRIYANI, NOVI

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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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THE EFFECT OF REMOTE ISCHEMIC PRECONDITIONING IN DIABETIC PATIENTS AFTER ELECTIVE PERCUTANEUS CORONARY INTERVENTION ANGGRIYANI, NOVI; PARAMITA, DONNA; RIFQI, SODIQUR
JNH (Journal of Nutrition and Health) Vol 3, No 2 (2015): JOURNAL OF NUTRITION AND HEALTH
Publisher : Universitas Diponegoro

Background Experimental and clinical investigations suggest that reperfusion is considered ?a double-edged sword?, as reperfusion would restore oxygen and nutrients supply to the ischemic myocardium to improve its functional recovery, but in the other hand reperfusion could augment myocardial ischemic damage, known as myocardial ischemia-reperfusion (I/R) injury. The brief and repeated cycles of I/R given at a distant organ before a sustained ischemia and reperfusion, known as remote ischemic preconditioning (RIPC), would protect the heart from lethal I/R injury. Objective The effect of ischemic preconditioning in a diabetic heart is a contradictory whether it could improve or worsen the damage degree of myocardial I/R injury, as reported by some previous studies. These inconsistent reports need further studies. Methods Twenty-four diabetic patients with stable CAD undergoing elective percutaneus coronary intervention were randomly assigned to 2 groups: 14 patients submitted to RIPC and 10 patients were control group. We induced RIPC by inflating a blood pressure cuff placed on the upper limb to 20 mmHg above systolic arterial pressure for 5 min and deflating the cuff for 5 min; 4 cycles were performed. All patients had CK-MB level measured at baseline and 18-24 hours after the elective PCI. Myocardial injury was considered when post-PCI CK-MB level rose up to 1-3 fold of the upper normal limit. Results A higher proportion in control group (40%) experienced myocardial injury, compared with the group receiving RIPC (0%) (p = 0.02). The mean of baseline CK-MB was equal in both control and RIPC groups (19.07 ± 2.84 and 17.5 ± 2.32, respectively; p = 0.165). While the mean of post-PCI CK-MB level in two groups differed significantly (34.2 ± 10.43 and 24.42 ± 4.03, respectively; p = 0.017). Conclusions RIPC lower the incidence of myocardial injury in diabetic patients after elective percutaneus coronary intervention. These data suggest that diabetic patients still gain protection of RIPC.

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

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.

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