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All Journal Majalah Kedokteran Bandung eJournal Kedokteran Indonesia Jurnal Penyakit Dalam Indonesia
Sally Aman Nasution
Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSPUN Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Correlation between Serum Uric Acid Level and Severity of Coronary Artery Stenosis in Patients with Acute Coronary Syndrome Diding Heri Prasetyo; Sally Aman Nasution; Idrus Alwi; Murdani Abdullah
Majalah Kedokteran Bandung Vol 53, No 1 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v53n1.2221

Abstract

Acute coronary syndrome (ACS) is a life-threatening disease which remains one of the causes of high morbidity and mortality despite the current advances in treatment. The relationship between the serum uric acid  (SUA) level and ischemic heart disease continues to be controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between the two factors has not yet fully understood. Prior epidemiological evidence of the causal relationship between the too is still argumentative. Various studies have been done using the same methods; yet, the outcomes were different. This study aimeds to conduct a meta-analysis to synthesize the results of recent studies in order to obtain accurate quantitative data. This systematic study followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline and studies published in the period of  January 2010 to May 2020 were screened using the Cochrane Library, Ebsco, Medline/PubMed, ProQuest and Science Direct as the sources. Meta-analysis was conducted to synthesize the association between the SUA level and severity of coronary artery stenosis using random effect model to account for possible study heterogeneity. Heterogeneity was assessed using I2 and the meta-analysis was performed using Comprehensive Meta Analysis Version 3 (CMA3) software. Five studies (n = 601 subjects) identified a correlation between serum uric acid level and Gensini score (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis, whereas publication bias was not found. Thus, the severity of coronary artery stenosis in patients with ACS is positively correlated with serum uric acid level.
In-Hospital Major Adverse Cardiac Events Factor Predictors on ST-Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention at dr. Cipto Mangunkusumo General Hospital Sally Aman Nasution; Hendra Perkasa; Eka Ginanjar; Ikhwan Rinaldi
eJournal Kedokteran Indonesia Vol. 10 No. 2 - Agustus 2022
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.10.193.107-13

Abstract

Major Adverse Cardiac Events (MACE) are the main causes to increase mortality in ST-Elevation Myocardial Infarction (STEMI) patients who undergo Primary Percutaneous Coronary Intervention (PPCI). In-hospital MACE inducing factor predictors identification is expected to enhance STEMI patients’ care and outcome. This study aims to identify in-hospital MACE factor predictors in STEMI patients with PPCI treatment at RSCM. Retrospective cohort study by tracing medical records on patients with PPCI treatment at RSCM from January 2015 - March 2020. The chi-squared bivariate analysis concluded between predictor factors; age, smoking, hypertension, diabetic Mellitus, chronic kidney disease, time-to-treatment, Killip class, left ventricle ejection fraction (LVEF) and LDL cholesterol level. Logistic regression is used in multivariate and prediction model analysis on variables with p<0,25 in bivariate analysis. This study involves 291 patient subjects. The occurrence of MACE is 43.3% on patients age > 60 years (29,6%), smoking (61,2%), hypertension (50,9%), diabetes mellitus (36,1%), chronic kidney disease (6,2%), Killip class II-IV (32,2%), LVEF > 50% (57%) dan cholesterol LDL level > 100 mg/dl (79,4%). Median time-to-treatment is 528 (379-730) minutes. Age, Killip class, and LVEF influences in-hospital MACE during PPCI with OR (95% CI) consecutively are 2,15 (1,22-3,79), 4,34 (2,49-7,56) and 2,88 (1,72-4,82). MACE prediction model in this study produces area under curve (AUC) 0,729 (95% CI 0,67-0,78). In-hospital MACE on STEMI patients after PPCI occurrence is 43.3%, influenced by age, Killip class, and LVEF. Keywords: major adverse cardiac events, primary percutaneous coronary intervention, myocardial infarction.   Faktor Prediktor Major Adverse Cardiac Events Selama Perawatan pada Pasien ST-Elevasi Miokard Infark yang Menjalani Intervensi Koroner Perkutan Primer di RSUPN dr. Cipto Mangunkusumo Abstrak Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya mortalitas pada pasien STElevasi Miokard Infark (STEMI) yang menjalani intervensi koroner perkutan primer (IKPP). Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE selama perawatan diharapkan dapat meningkatkan perawatan dan luaran klinis dari pasien STEMI. Penelitian ini bertujuan untuk mengetahui faktor prediktor MACE selama perawatan pada pasien STEMI yang dilakukan IKPP di RSCM. Studi kohort retrospektif dengan menelusuri rekam medis pasien yang menjalani IKPP di RSCM periode Januari 2015-Maret 2020. Dilakukan analisa bivariat antara faktor prediktor usia, status merokok, hipertensi, diabetes mellitus, penyakit ginjal kronik, time-to-treatment, kelas killip, fraksi ejeksi ventrikel kiri (FEVK) dan kadar kolesterol LDL dengan kejadian MACE selama perawatan pada pasien STEMI yang menjalani IKPP, menggunakan metode Chi-square. Analisa multivariat dan analisa model prediksi dilakukan dengan metode regresi logistik terhadap variabel dengan nilai p= <0,25 pada analisa bivariat.Didapatkan subyek sebanyak 291 pasien untuk diteliti. Major Adverse Cardiac Events selama perawatan didapatkan sebesar 43,3% dengan usia >60 tahun (29,6%), status merokok (61,2%), hipertensi (50,9%), diabetes mellitus (36.1%), penyakit ginjal kronik (6,2%), kelas Killip II-IV (32,2%), FEVK > 50% (57%) dan kadar kolesterol LDL > 100 mg/dl (79,4%). Median timeto-treatment didapatkan sebesar 528 (379-730) menit. Usia, kelas killip dan FEVK mempengaruhi kejadian MACE selama perawatan dengan OR (IK 95%) masing-masing 2,15 (1,22-3,79), 4,34 (2,49-7,56) dan 2,88 (1,72-4,82). Model prediksi MACE selama perawatan pada pasien STEMI yang menjalani IKPP memiliki nilai area under curve (AUC) 0,729 (IK 95% 0,67-0,78). Major Adverse Cardiac Events (MACE) selama perawatan Kata kunci: major adverse cardiac events, intervensi koroner perkutan primer, infark miokard.
Pengaruh Fungsi Ginjal Sebelum Intervensi Koroner Perkutan Primer Terhadap Perbedaan Kesintasan 30 Hari Pasien Infark Miokard Elevasi Segmen ST Fahmi Razi Darkuthni; Sally Aman Nasution; Aida Lydia; Murdani Abdullah; Dono Antono; Cleopas Martin Rumende; Maruhum Bonar Hasiholan Marbun; Hamzah Shatri; Arif Mansjoer; Ika Prasetya Wijaya; Lusiani Lusiani
eJournal Kedokteran Indonesia Vol 10, No. 3 - Desember 2022
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.10.195.204-11

Abstract

Penyakit jantung koroner merupakan penyebab kematian penyakit kardiovaskular utama di Indonesia. Revaskularisasi fase akut secara mekanis maupun farmakologis merupakan tatalaksana utama pada STEMI. Mortalitas paska revaskularisasi masih tinggi. Salah satu faktor penting yang memengaruhi kesintasan pasien STEMI adalah fungsi ginjal. Gangguan fungsi ginjal yang dicerminkan dengan estimated glomerulus filtration rate (eGFR) < 60 diketahui berhubungan dengan perfusi miokard yang buruk paska IKP primer. Penelitian ini bertujuan untuk memberikan gambaran karakteristik pasien STEMI yang menjalani IKP primer berdasarkan fungsi ginjal sebelum IKP dan menganalisa perbedaaan kesintasan dalam 30 hari pasien STEMI-IKP primer berdasarkan fungsi ginjal sebelum IKP. Metode studi observasional kohort retrospektif dan pengukuran fungsi ginjal dikelompokkan berdasarkan eGFR dengan rumus CKD-EPI menjadi dua yaitu eGFR < 60 dan eGFR ≥ 60. IKP primer dilakukan pada 211 pasien STEMI. Insiden mortalitas eGFR < 60 sebesar 14,7%, sedangkan dengan eGFR ≥ 60 sebesar 4,4%. Perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR (p < 0,05) dengan crude HR (IK95%) 3,433 (1,269-9,284). Tidak terdapat perbedaan kesintasan pasien STEMI-IKP antar-kelompok eGFR setelah di-adjusted. Mortalitas dalam 30 hari pada kelompok eGFR < 60 lebih tinggi dibandingkan dengan kelompok eGFR ≥ 60. Kata kunci: infark miokard akut, intervensi koroner perkutan, fungsi ginjal, mortalitas.
Validity of Simple Risk Index and Evaluation of Methods andManagement of Acute Coronary Events to Predict Mortality inAcute Coronary Syndrome Patients in Intensive Coronary CareUnit Cipto Mangunkusumo Hospital Meutia, Rahmah Safitri; Nasution, Sally Aman; Makmun, Lukman H
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
Publisher : UI Scholars Hub

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Abstract

Introduction. Risk stratification is an important part in the management of patients with an Acute Coronary Syndrome (ACS) to avoid overtreatment or undertreatment. Although Simple Risk Index (SRI) and Evaluation of Methods and Management of Acute Coronary Events (EMMACE) have been validated in other countries, no study of its applicability has been performed in Indonesia with different patients’ characteristics. This study aims to obtain the calibration and discrimination performance of SRI and EMMACE to predict 30 days mortality in ACS patients in ICCU of Cipto Mangunkusumo Hospital. Methods. A retrospective cohort study with consecutive sampling was conducted in ACS patients hospitalized in the ICCU Cipto Mangunkusumo hospital between the period of 2003 up to 2010. Data analyzed performed by SPPS program for Windows Version 17. The discrimination performance was explained using a value of area under the receiver-operator curve (AUC) while calibration performance was evaluated using hosmer lemeshow and plot calibration. Results. A total of 922 patients were included in this study consisted of 453 STEMI patients, 234 NSTEMI patients and 235 UAP patients. Simple Risk Index (SRI) score for STEMI had presentable discrimination and calibration performance (AUC= 0,92; R2 = 0,98; and p value= 0,01). Simple Risk Index (SRI) score for overall ACS also showed sufficient performance and calibration discrimination (AUC= 0,87; R2 = 0,99; and p value= 0,52). Meanwhile, EMMACE score in ACS patients showed satisfactory performance discrimination (AUC= 0,87), but the calibration perfomance was not as satisfactory as the SRI score with the calibration plot (R2 )= 0,54 (p value= 0,52). Conclusions. Simple Risk Index (SRI) score shows a satisfactory discrimination and calibration performance both in STEMI and overall ACS patients in predicting mortality of ACS patients in ICCU Cipto Mangunkusumo Hospital. Evaluation of Methods and Management of Acute Coronary Events (EMMACE) score, nonetheless, displays sufficient discrimination performance, but poor performance of calibration.
The Role of Duke Treadmill Score as a Predictor of CoronaryArtery Disease in Patients with Positive Treadmill Test Results Ikhsan, Muhammad; Nasution, Sally Aman; Wijaya, Ika Prasetya; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 2
Publisher : UI Scholars Hub

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Abstract

Introduction. Coronary Artery Disease (CAD) is one of the disease entity that leading cause of morbidity and mortality in worldwide. Treadmill test is part of the diagnostic modality which readily available to assess possibility of narrowing coronary artery and guiding us whether we need for the further investigation. Despite of that, treadmill test has limitation in diagnostic accuracy. Duke Treadmill Score (DTS) was also tested as a diagnostic score, and shown to predict significant CAD better than the ST-segment response alone. Methods. This is a cross-sectional study performed in adult patients with stable CAD that underwent treadmill test and coronary angiography in outward patient clinic of the Integrated Cardiac Service in Cipto Mangunkusumo Hospital between January 2011 and December 2013. Results. A total of 103 patients in this study, thirty nine patients (37,9 %) had significant CAD in coronary angiography. Briefly, mean age was 54,71 years and 55 patients (53,4 %) were females. The most common CAD risk factor was hypertension (51,5 %). A mean of DTS score was -3.53, which mostly categorized as intermediate risk (89,3 %). Based on DTS results, cut-off point was determined by using Receiver Operator Curve (ROC) method, in which value of -8,85 considering as a cut-off point. Sensitivity and specificity value of DTS were 28 % (CI 95 %: 17 % to 44 %), and 95 % (CI 95 %: 87 % to 98 %). Positive and negative predictive value were 79 % (CI 95 %: 52 % to 92 %) and 69 % (CI 95 %: 58 % to 77 %). Positive and negative likelihood ratio were 6.02 and 0.75. Conclusions. DTS has a good performance in predicting significant CAD at cut-off point -8,85 in patients with positive treadmill test.
Pendekatan Diagnosis dan Tatalaksana Infark Ventrikel Kanan HS, R Fidiaji; Nasution, Sally Aman
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
Publisher : UI Scholars Hub

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Abstract

Fungsi optimal jantung merupakan hasil interaksi dari berbagai bagian jantung, baik ventrikel kiri maupun ventrikel kanan. Namun, perkembangan diagnosis dan tatalaksana kegawatan jantung umumnya berpusat pada disfungsi ventrikel kiri. Perkembangan keilmuan saat ini memperlihatkan bahwa disfungsi ventrikel kanan juga mengakibatkan gangguan hemodinamik yang signifikan dan membutuhkan tatalaksana yang berbeda dengan tatalaksana disfungsi ventrikel kiri. Infark ventrikel kanan umumnya bukan merupakan suatu kasus tunggal, namun seringkali menyertai infark ventrikel kiri. Identifikasi infark ventrikel kanan pada kondisi tersebut, dapat mempengaruhi tatalaksana yang dilakukan pada suatu sindrom koroner akut.
Retraction: Correlation of Serum Uric Acid Levels with The Severity Of Coronary Artery Stenosis in Patients with Acute CoronarySyndrome: Meta-Analysis Study Prasetyo, Diding Heri; Nasution, Sally Aman; Alwi, Idrus; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
Publisher : UI Scholars Hub

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Abstract

Introduction. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different. This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately. Methods. This study protocol was registered with PROSPERO (CRD42020210948), and conducted according to PRISMA guidelines, tracing studies published in vulnerable periods from January 2010 to May 2020. The Cochrane Library, EBSCO, Medline/PubMed, ProQuest and Science Direct are sources of published studies. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis, using random effect model to account for possible study heterogeneity. Heterogeneity was assessed using I2 , and the meta-analysis was performed using comprehensive meta-analysis version 3 (CMA3) software. Results. Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis, whereas publication bias was not found. There was a moderate positive correlation between serum uric acid levels and the severity of coronary artery stenosis, with a correlation coefficient of 0.548 (p value <0.001).
Correlation of Haemoglobin Platelet Ratio (HPR) and LeukocytePlatelet Ratio (LPR) with SYNTAX-2 Score in STEMI Patients Ikhsan, Muhammad; Nasution, Sally Aman; Rachman, Andhika; Muhadi, Muhadi
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
Publisher : UI Scholars Hub

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Abstract

Introduction. Various studies have concluded the association between various markers of inflammation with the clinical outcome in STEMI patients. However, most of these markers are quite expensive and not available in healthcare facilities. Hence, we aim to study the correlation between haemoglobin platelet ratio (HPR) and leucocyte platelet ratio (RPL) and the clinical outcomes of STEMI patients. Methods. This is a cross-sectional study performed in adult patients with STEMI who were hospitalized in Intensive Coronary Care Unit Cipto Mangunkusumo Hospital between January 2016 and October 2020. The data was analyzed by testing the correlation between HPR and LPR with SYNTAX-2 score. Results. There were 114 subjects in this study, with a mean age was 53.87 years and dominated by male (86.8%). We found no correlation between HPR and LPR with SYNTAX-2 Score. From the sub-group analysis, there was a moderate positive correlation between HPR and SYNTAX-2 score (r = 0.587; p= 0.005) and a strong positive correlation between LPR and SYNTAX-2 score (r = 0.606; p = 0.004) in subjects with normal body mass index (BMI). Additional results obtained a strong negative correlation between neutrophil lymphocyte ratio (NLR) with SYNTAX-2 score (r = -0.738; p= 0.0037) and a very strong negative correlation between platelet lymphocyte ratio (PLR) with SYNTAX-2 score (r= -0,857; p= 0,007) in subjects with low BMI. Conclusion. There is no correlation between HPR and LPR with SYNTAX-2 Score
Cardiotoxicity Complication of Radiotherapy Wisman, Beta Agustia; Nasution, Sally Aman; Panggabean, Marulam M
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
Publisher : UI Scholars Hub

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Abstract

Radiation is an important modality in the management of malignancy. Some cases of malignancy requiring radiotherapy in the chest include breast cancer, Hodgkin's lymphoma, or lung cancer.Cardiotoxicity due to radiotherapy can occur within 3 to 29 years after radiotherapy, mostly in the second or third decade after therapy. Some cardiovascular complications resulting from radiotherapy may affect pericardial, myocardial, vascular, heart valves and conduction disturbances. Symptomatic cardiotoxicity may occurs 10% in patients undergoing radiotherapy in the chest area. It is important for clinicians to understand the cardiotoxicity of radiotherapy for educational purposes, therapeutic and dosing considerations, treatment monitoring and early detection. Early detection and post-radiation monitoring have an important role to reduce morbidity and mortality due to cardiovascular disease after radiotherapy and comprehensive management is necessary
Right Ventricular Systolic and Diastolic Function Profile inPatient with Stable Chronic Obstructive Pulmonary Disease Oktavia, Dina; Nasution, Sally Aman; ZN, Anna Uyainah; Rumende, C Martin
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Introduction. Right ventricular dysfunction is one of the common complication of chronic obstructive pulmonary disease (COPD). Right ventricular assessment is importance, since it related with exercise intolerance and poor prognosis. Methods. Thirty stable COPD men (mean age: 65 ± 6 yr) underwent spirometry. In addition to conventional echocardiographic parameters, TAPSE, right heart chambers, and trans tricuspid inflow were determined. Results. The mean value of FEV1 was 28 ± 8% of the predicted value. There was no subject with mild airflow limitation, 57% subjects were with very severe airflow obstruction. All of pulmonary function test showed mixed restrictive-obstructive pattern. Mean of right chamber was in normal limit. Forty percent of the patients suffered right ventricular diastolic dysfunction. Means of TAPSE was 16.96 ± 96 mm. Sixty percent of the patients suffered right ventricular systolic dysfunction. There was no significant difference in TAPSE between groups with moderate-severe flow obstruction and very severe airflow obstruction. There was no significant correlation between FEV1 % prediction and TAPSE, so the cut-off value between the two variables cannot be determined. Conclusions. The proportion of right ventricular systolic dysfunction was 60% and diastolic dysfunction was 40%. There was no correlation between FEV1 % prediction and TAPSE. The cut-off value between the two variable in stable COPD patients cannot be determined.
Co-Authors A.A. Ketut Agung Cahyawan W Achmad, Ibrahim Aida Lydia Andhika Rachman Anna Uyainah Anna Uyainah Arif Mansjoer Aulia Rizka, Aulia Beta Agustia Wisman Beta Agustia Wisman, Beta Agustia C Martin Rumende C Martin Rumende Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Cleopas Martin Rumende Dicky Levenus Tahapary Diding Heri Prasetyo Diding Heri Prasetyo Dina Oktavia Dina Oktavia Dono Antono Dyah Purnamasari E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Eka Ginanjar Esthika Dewiasty Esthika Dewiasty, Esthika Fahmi Razi Darkuthni Hendra Perkasa HS, R Fidiaji Idrus Alwi Idrus Alwi Idrus Alwi Ika Prasetya Wijaya Ikhwan Rinaldi Juferdy Kurniawan Kemal Fariz Kalista, Kemal Fariz Leonard Nainggolan Lukman H Makmun Lukman H Makmun Lusiani Lusiani Maruhum B.H. Marbun Marulam M Panggabean Marulam M Panggabean, Marulam M Muhadi Muhadi Muhadi Muhadi, Muhadi Muhammad Ikhsan Muhammad Ikhsan Murdani Abdullah Nababan, Saut Horas Hatoguan Pratama, Derin Anugrah R. Fidiaji H Santoso R. Fidiaji H Santoso, R. Fidiaji H Rahmah Safitri Meutia Rahmah Safitri Meutia, Rahmah Safitri RR. Ella Evrita Hestiandari Sari, Ifani Media Sari, Nina Kemala Sukamto Koesnoe Wulyo Rajabto ZN, Anna Uyainah