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INDONESIA
Indonesian Journal of Cardiology
Published by Indonesian Heart Association
ISSN : 28303105     EISSN : 29647304     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Indonesian Journal of Cardiology (IJC) is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI) [www.inaheart.org] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies. Subjects suitable for publication include but are not limited to the following fields: Acute Cardiovascular Care Arrhythmia / Cardiac Electrophysiology Cardiovascular Imaging Cardiovascular Pharmacotherapy Cardiovascular Public Health Policy Cardiovascular Rehabilitation Cardiovascular Research General Cardiology Heart Failure Hypertension Interventional Cardiology Pediatric Cardiology Preventive Cardiology Vascular Medicine
Arjuna Subject : Kedokteran - Cardiology and Cardiovascular Medicine
Articles 794 Documents
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Prevalence and Lipid Profile Associations of Elevated Lipoprotein(a) Among Indonesian Adults: A Cross-Sectional Study Jason Wirandy Haryanto; Kevin Jonatan Sandi; Surya Sinaga Immanuel; Angely Christie Rumayar; Leonardo Paskah Suciadi
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1846

Abstract

Background: Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein and an independent risk factor for Atherosclerotic Cardiovascular Disease (ASCVD). While 20–30% of adults worldwide have elevated Lp(a), data from Indonesia remain scarce. Given reported differences by sex and metabolic profile, this cross-sectional study aimed to determine the prevalence of elevated Lp(a) and its associations with lipid parameters and Hemoglobin A1c (HbA1c) among adults undergoing routine health screening at a tertiary hospital in Indonesia. Methods: This cross-sectional study analyzed data from 904 adults who underwent routine health screening at Siloam Hospitals Kebon Jeruk, Jakarta (2021–2024). Data on Lp(a), lipid profile, and HbA1c were extracted from the medical records. The normality of data was assessed using the Shapiro–Wilk test. Group comparisons were performed using the Mann–Whitney U test, and correlations between log-transformed Lp(a) and metabolic parameters were evaluated using Spearman correlation and simple linear regression. Results: Among 904 participants, 18.8 % had elevated Lp(a) levels (> 30 mg/dL). Females showed significantly higher Lp(a) concentrations than males (p = 0.008). Low-Density Lipoprotein Cholesterol (LDL-C) levels were slightly higher in participants with elevated Lp(a) but did not differ significantly (p = 0.19). On linear regression, LDL-C was positively associated with log-transformed Lp(a) (B = 0.002, p < 0.001), whereas triglycerides were inversely associated (B = ?0.001, p = 0.029); no significant relationships were observed for High-Density Lipoprotein Cholesterol (HDL-C) or HbA1c. Conclusion: Nearly one in five adults undergoing routine health screening in this Indonesian cohort had elevated Lp(a) levels. Females exhibited significantly higher Lp(a) concentrations than males, and LDL-C showed a modest positive association with Lp(a). These findings reinforce the relevance of Lp(a) as an important, genetically influenced cardiovascular risk marker and support routine Lp(a) screening for improved risk stratification in clinical practice.
Multifocal Atrial Tachycardia in a 9-Month-Old Infant: A Case Report with Therapeutic Insights Diego Chemello; Camila Sales Fagundes; Patricia Chagas; Leticia Hadlich Correa de Barros; Patricia Rodrigues Lemos Cardoso
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1889

Abstract

Background: Supraventricular tachycardia is the most common arrhythmia in infants, with an estimated prevalence between 1/250 and 1/1000. Multifocal Atrial tTachycardia (MAT), a rare subtype accounting for less than 1% of supraventricular tachycardia in infants and children, is characterized by multiple atrial foci, variable P-wave morphologies, and irregular ventricular response. When incessant, MAT may lead to tachycardia-induced cardiomyopathy and congestive heart failure. This report describes a 9-month-old infant with MAT and left ventricular dysfunction, emphasizing diagnostic challenges and therapeutic strategies Case Illustration: A previously healthy 9-month-old female infant presented for urgent evaluation due to progressive dyspnea and tiredness during breastfeeding, which had begun approximately two months earlier and worsened in the last two weeks. Her mother noted perioral cyanosis during crying and feeding. On examination, she was tachypneic (60 breaths/min), tachycardic (180 bpm), and mildly dehydrated. Transthoracic echocardiography revealed a dilated left ventricle with moderate systolic dysfunction (ejection fraction 35%). A 12-lead electrocardiogram demonstrated multifocal atrial tachycardia with at least three distinct P-wave morphologies and irregular R-R intervals, and Holter monitoring confirmed an incessant pattern (>30% of the day). Three synchronized direct current cardioversion attempts (0.5, 1.0, and 1.23 J/kg) failed to restore sinus rhythm. Intravenous amiodarone was initiated (loading dose 5 mg/kg over 1 hour, followed by 10 mcg/kg/min), later transitioned to oral therapy (5 mg/kg/day). Within 48 hours, sinus rhythm was restored, heart failure symptoms resolved, and follow-up echocardiography showed improved ejection fraction (55%). Propranolol (1 mg/kg/day) and digoxin (5 mcg/kg/day) were added for rate control. The patient was discharged asymptomatic after one week, with no relapse at 6-month follow-up. Conclusions: MAT is a rare cause of supraventricular tachycardia in infants and may be present with congestive heart failure due to tachycardia-induced cardiomyopathy. Incessant forms are typically defined by an arrhythmia burden greater than 30% of the day on Holter monitoring. Failure of direct current cardioversion is a hallmark of MAT, reinforcing the role of pharmacological management. Early recognition and rate and rhythm control with agents such as amiodarone, propranolol, and digoxin can lead to rapid recovery of left ventricular function and an excellent prognosis in infants without structural heart disease.
Aerobic Exercise Only or in Combination with Resistance Exercise Provides a Significant Reduction in Blood Pressure: A Narrative Review Winda Nurhamda; Arnengsih Nazir; Tertianto Prabowo
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1891

Abstract

Hypertension is a major global health concern and a leading risk factor for cardiovascular disease. While pharmacological therapy remains central, lifestyle interventions, particularly Aerobic Exercise (AE), offer a cost-effective, safe, and sustainable strategy for reducing Blood Pressure (BP) and improving cardiovascular health. Evidence indicates AE consistently lowers Systolic Blood Pressure (SBP) more than Diastolic Blood Pressure (DBP), with clinically meaningful reductions in both. This review aimed to synthesize current evidence on the effects of AE, alone or combined with Resistance Training (RT) or dietary interventions, on BP in individuals with hypertension, elucidate underlying mechanisms, identify moderating factors, and evaluate safety considerations. A narrative review of English-language articles published from 2015 to 2025 was conducted via PubMed, including original and review studies, as well as selected textbooks. Keywords included “aerobic exercise”, “exercise”, “hypertension”, “blood pressure”, “coronary artery disease”, and “cardiovascular disease”. Eligible studies were synthesized into themes reflecting acute and chronic exercise responses, combination interventions, mechanistic pathways, influencing factors, and safety. Thirty-four publications (26 original articles, 6 reviews, 2 textbooks) were included. AE alone or combined with RT consistently reduced SBP, with smaller reductions in DBP, whereas the combination with a hypocaloric diet primarily enhanced cardiorespiratory fitness and body composition. Mechanisms include improved endothelial function, autonomic regulation, metabolic efficiency, and anti-inflammatory effects. Effect size was influenced by age, sex, Body Mass Index (BMI), medication use, exercise timing, and vascular stiffness. Safety data indicated high tolerability, minimal adverse events, and strong adherence. AE is a safe and effective non-pharmacological intervention for hypertension, producing clinically significant BP reductions, particularly in SBP. Combining AE with RT or dietary modification offers additional cardiometabolic benefits. These findings reinforce AE as a cornerstone of hypertension management and support its integration into routine clinical practice.
Serum Endothelin-1 Level >2.0 pg/mL associates with High-Risk Duke Treadmill Score among Chronic Coronary Syndrome Patients Muhammad Sarwansyah Putra; Irsad Andi Arso; Ira Puspitawati; Anggoro Budi Hartopo
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1907

Abstract

Background: Chronic coronary syndrome (CCS) contributes to morbidity and increased risk of acute coronary syndrome within 5 years. Duke Treadmill Score (DTS) is the most robust risk stratification based on cardiac exercise stress test, which predicts 5-year survival. Those with high-risk DTS (DTS ?11) had the least favorable survival. Endothelin-1, a potent vasoconstrictor peptide, affects the 5-year survival in CCS. This study aimed to investigate the association between serum endothelin-1 level and DTS risk stratification among Indonesian patients with CCS. Methods: This was a cross-sectional study that recruited consecutive patients with CCS after Coronary Angiography (CAG). The DTS data were collected from the previous Treadmill Test (TMT) and were classified into high-risk DTS (DTS ?-11) and low-moderate-risk DTS (DTS >-11). A serum sample for measuring endothelin-1 was withdrawn during CAG and used in the ELISA protocol. A high endothelin-1 level was defined as > 2.0 pg/mL. An association between variables was assessed using statistical analysis (significance at p < 0.05). Results: Eighty subjects were enrolled. Median time interval of TMT and endothelin-1 measurement was 30 days. Mean age was 58.48±8.73 years old, with males predominant (82.5%). Hypertension (71.3%) and previous Acute Coronary Syndrome (ACS) (52.5%) were dominant. The proportion of subjects with high-risk DTS was 52.5%. Median endothelin-1 level was 1.8 pg/mL (range: 0.4 - 6.8 pg/mL). Serum endothelin-1 level > 2.0 pg/mL was observed in 34 subjects (42.5%), of whom 23 (67.6%) had high-risk DTS. There was a significantly increased risk of high-risk DTS in subjects with serum endothelin-1 >2.0 pg/mL (OR 2.97; 95% CI 1.18-7.51; p=0.020). Based on bivariate analysis, two variables, namely hypertension (p=0.052) and history of ACS (p=0.036), were also significantly associated with high-risk DTS. In multivariate analysis, endothelin-1 level >2.0 pg/mL had an adjusted OR of 1.75 (95% CI: 0.60-5.13, p=0.305), indicating no statistically significant independent association with high-risk DTS. Hypertension and a history of ACS had an independent and significant association with high-risk DTS. Conclusion: Among CCS patients, serum endothelin-1 level > 2.0 pg/mL was associated with high-risk DTS from TMT examination. However, this association was not independent, as in hypertension and history of ACS.
Myocarditis Mimicking STEMI Complicated by Complete Atrioventricular Block: Diagnostic and Therapeutic Insights Rido Mulawarman; Hiradipta Ardining; Celly Anantaria Atmadikoesoemah; Dony Yugo Hermanto; Bambang Widyantoro; Rarsari Soerarso
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1921

Abstract

Background: Myocarditis, or myocardial inflammation, may share similar characteristics to Acute Coronary Syndrome (ACS), particularly ST-Elevation Myocardial Infarction (STEMI). This condition is further augmented when a Complete Atrioventricular Block (CAVB) is present. Despite being rare, this condition may pose additional diagnostic and therapeutic challenges. Case Illustration: We report a 54-year-old woman with fatigue, dyspnea, fever, nausea, and watery diarrhea for three days. Upon admission, she experienced hypotension, pulmonary congestion, and a complete Atrioventricular (AV) block, with ST-segment elevation seen on the lateral leads. Initial laboratory results revealed markedly elevated high-sensitivity troponin T and C-reactive Protein (CRP). Bedside echocardiography showed a prominently reduced Ejection Fraction (EF) (40%) alongside the presence of regional wall motion abnormalities. Urgent coronary angiography revealed only non-obstructive coronary disease and no obstructive coronary disease. A temporary pacemaker and inotropic support were initiated. Given the presence of systemic prodromal symptoms and the absence of coronary obstruction, myocarditis was strongly suspected. High?dose intravenous methylprednisolone was given as an anti?inflammatory treatment in suspected fulminant myocarditis with cardiogenic shock and complete AV block. Recognizing that immunosuppressive therapy is not routinely recommended for all myocarditis cases, especially without biopsy confirmation. Cardiac magnetic resonance imaging subsequently confirmed myocarditis, demonstrating myocardial edema and subepicardial late gadolinium enhancement. The patient was discharged after receiving guideline-directed medical therapy and tapering corticosteroids, with preserved ventricular function on follow-up 1 month after discharge. Conclusions: This report illustrates the importance of a stepwise diagnostic approach to differentiate myocarditis from STEMI, particularly when complicated by conduction disturbances such as CAVB. Early recognition and timely initiation of immunosuppressive therapy can lead to favorable outcomes.
Soluble ST2 as a Marker of Subclinical Right Ventricular Dysfunction in Pulmonary Hypertension Associated With Congenital Heart Disease Fadhil Alfino Azmi; Mefri Yanni; Kino Kino; Hirowati Ali
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1930

Abstract

Background: Congenital Heart Disease with Pulmonary Hypertension (CHD-PH) increases Right Ventricular (RV) afterload, which may lead to subclinical myocardial impairment before overt systolic dysfunction becomes apparent. Early detection is crucial to prevent progression to right heart failure. Global Longitudinal Strain (GLS) by echocardiography is sensitive for identifying subclinical RV dysfunction despite preserved conventional systolic parameters, but the role of molecular biomarkers remains unclear. Soluble Suppression of Tumorigenicity 2 (sST2) has been proposed as a potential biomarker for subclinical RV dysfunction. This study aims to compare sST2 levels in CHD-PH patients with and without subclinical RV dysfunction as assessed by RV-Global Longitudinal Strain (RV-GLS). Methods: This cross-sectional study included adult CHD-PH patients (?18 years) at the Integrated Heart Center, RSUP M. Djamil Padang, from January to June 2025. All participants underwent right heart catheterization and had preserved RV systolic function, as assessed by conventional echocardiography (Three-Dimensional Right Ventricular Ejection Fraction [3D RVEF] ?45%). RV-GLS was assessed using Speckle-Tracking Echocardiography (STE), and serum sST2 levels were measured. Patients were categorized into subclinical RV dysfunction (GLS > –20%) and without subclinical RV dysfunction (GLS ? –20%) groups. Statistical analysis was performed to compare sST2 levels between groups. Results: Thirty-four patients were included (82% female, mean age 37.8 ± 15.6 years), with secundum Atrial Septal Defect (ASD) as the most common etiology (71%). Median sST2 levels in patients with CHD-PH without subclinical RV dysfunction were 15.65 (6.05–40.90) ng/mL, with a GLS of –20.50 (–27.20 to –20.00)%. In patients with CHD-PH with subclinical RV dysfunction, median sST2 was 15.15 (5.25–47.60) ng/mL, with a GLS of –11.80 (–19.90 to –6.20)%. No statistically significant difference in sST2 levels was observed between groups (p = 0.89). In contrast, patients with CHD-PH with subclinical RV dysfunction exhibited significantly higher indexed Pulmonary Arterial Resistance (PAR) and pulmonary-to-Systemic Vascular Resistance ratio (PAR/SVR ratio), indicating increased pulmonary vascular load despite preserved conventional RV systolic function. Conclusion: sST2 levels did not differ significantly between CHD-PH patients with subclinical RV dysfunction and those without. Subclinical RV dysfunction was associated with higher pulmonary vascular load, as reflected by increased indexed PAR and PAR/SVR ratio, despite preserved conventional RV systolic function. From this may conclude that subclinical RV myocardial impairment in CHD-PH is more closely related to hemodynamic afterload than to molecular stress biomarkers alone. These findings suggest that sST2 alone may have limited utility as a biomarker for detecting subclinical RV myocardial impairment in this population.
Cardiac Tamponade due to Purulent Pericarditis Jessica Anastasia Setiawan; Danayu Sanni Prahasti
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1963

Abstract

Background: Purulent pericarditis, though uncommon in the antibiotic era, remains highly fatal when diagnosis or drainage is delayed. Its presentation often mimics viral hepatitis, sepsis, or parasitic infections—particularly in endemic, low-resource regions—leading to underrecognition. This case reported the development of purulent pericarditis with initial equivocal signs and symptoms, followed by progressive hemodynamic deterioration. Case Illustration: A 40-year-old previously healthy man presented with fever, dyspnea, stabbing chest and abdominal pain, and dark urine. Examination revealed jaundice, pericardial friction rub, and hepatosplenomegaly. Laboratory tests showed leukocytosis, hyperbilirubinemia, and elevated liver enzymes. Initial echocardiography demonstrated a 2-cm circumferential effusion without signs of tamponade. Two days later, despite stable symptoms, he developed hypotension with new fibrinous effusion and right atrium collapse. Emergency pericardiocentesis drained 1.7 L of thick, purulent fluid. Hemodynamics improved rapidly after drainage. Prednisone and colchicine were initiated once infection control was achieved to limit fibro-inflammatory response and reduce the risk of constriction. Liver function normalized, and follow-up echocardiography showed minimal residual effusion. At follow-up, the patient remained asymptomatic. Conclusion: This case highlights that purulent pericarditis can occur in immunocompetent individuals without typical risk factors, possibly from overlooked infection in low-resource settings. Hemodynamic collapse may occur even with small increases in pericardial effusion volume, owing to fibrin-induced pericardial stiffness and reduced compliance. Serial echocardiography is therefore critical when symptoms appear stable. Early pericardiocentesis is both diagnostic and therapeutic, reducing bacterial and inflammatory load, while carefully selected adjunctive anti-inflammatory therapy may prevent chronic constrictive sequelae.
Correlation Between Six-Minute Walk Test and Treadmill Exercise in Post-Coronary Artery Bypass Phase II Rehabilitation Patients: A Cross-Sectional Study Tresia Fransiska Ulianna Tambunan; Audrey Witari; Helisa Rachel Patricie Sianipar
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1969

Abstract

Background: Coronary Artery Bypass Grafting (CABG) improves survival in advanced Coronary Artery Disease (CAD) but is often associated with reduced functional capacity during recovery. Phase II cardiac rehabilitation improves physical performance, yet accessible and reliable tools are needed to monitor progress. Treadmill Cardiopulmonary Exercise Testing (CPET) is the gold standard for assessing aerobic capacity, but it is resource-intensive and not widely available in many settings. The Six-Minute Walk Test (6MWT) is a simple alternative, but its validity compared with treadmill testing in Indonesian post-CABG patientsremains underexplored Methods: This cross-sectional study was conducted at the National General Hospital Dr. Cipto Mangunkusumo in Jakarta between May 2023 and October 2024. Post-CABG patients who completed an eight-week Phase II cardiac rehabilitation program, were clinically stable, and able to perform both assessments were included. Functional capacity was determined by estimated VO2Max from the 6MWT and directly measured VO2Max from a symptom-limited treadmill test using the Modified Bruce protocol. Descriptive statistics summarized baseline characteristics. Spearman correlation coefficient was used to evaluate the relationshipbetween the two tests, with statistical significance set at p<0.05. Results: Fifteen post-CABG patients completed the study. Most were male (73.3%) with a mean age of 59 years. Overweight status was common (46.7%), with hypertension (80.0%), dyslipidemia (66.7%), and diabetes mellitus (53.3%) as frequent comorbidities. Mean 6MWTdistance increased from 307.8 ± 85.7 m pre-rehabilitation to 498.5 ± 140.7 m post-rehabilitation. The estimated VO2Max from the 6MWT followed a normal distribution and is reported as a mean of 18.9 mL/kg/min (SD = 4.2). In contrast, the treadmill-measured VO2Max was nonnormally distributed and is therefore reported as a median of 21.4 mL/kg/min. A significant moderate positive correlation was found between 6MWT and treadmill VO2Max (r = 0.689, p = 0.005). Conclusion: The 6MWT demonstrated a strong, significant correlation with treadmill-based VO2Max, supporting its use as a practical and cost-effective alternative for functional capacity assessment in post-CABG Phase II rehabilitation. Routine integration of the 6MWT may facilitate individualized exercise prescription and enhance patient monitoring, particularly in resource-limited settings.
Utilization of Neuromuscular Electrical Stimulation as a Rehabilitation Treatment in Heart Failure with Reduced Ejection Fraction: A Systematic Review and Meta-Analysis Bima Diokta Alparisi; Samira Amanda; Daniel Herman; Rosmaliana Rosmaliana; Irwan Irwan; Haryadi Haryadi
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1997

Abstract

Heart Failure with Reduced Ejection Fraction (HFrEF) is associated with substantial functional impairment, and many patients are unable to participate in conventional exercise-based cardiac rehabilitation. Neuromuscular Electrical Stimulation (NMES) has been proposed as an alternative rehabilitation treatment, but its clinical effectiveness remains uncertain. This review aims to evaluate the effectiveness of NMES in improving cardiac function and exercise capacity in patients with HFrEF. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing NMES with standard medical therapy, exercise training, or no intervention in adult patients with HFrEF were identified through major electronic databases. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Pooled effects were calculated as Mean Differences (MD) with 95% Confidence Intervals (CIs) using Review Manager (RevMan) version 5.4. Twelve RCTs involving 636 participants were included. NMES significantly improved peak oxygen uptake (VO2 peak) (MD 2.03 mL/kg/min; 95% CI 1.21 to 2.84; p < 0.00001), systolic blood pressure (MD ?2.02; 95% CI ?3.97 to ?0.06; p = 0.04), Left Ventricular Ejection Fraction (LVEF) (MD ?1.38%; 95% CI ?2.73 to ?0.03; p = 0.05), and Heart Rate (HR) (MD 2.19 beats/min; 95% CI 0.44 to 3.95; p = 0.01). A borderline significant improvement was observed in the Six-Minute Walk Test (6MWT) distance (MD ?11.40 m; 95% CI ?23.04 to 0.24; p = 0.05). No significant effects were found for diastolic blood pressure (MD ?0.12; 95% CI ?3.30 to 3.06; p = 0.94) or Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (MD 1.97; 95% CI ?9.06 to 13.01; p = 0.73). NMES is associated with meaningful improvements in exercise capacity and selected parameters of cardiac function in patients with HFrEF, supporting its role as a potential adjunct rehabilitation treatment.
One-Year Outcomes of Major Adverse Cardiac Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Delayed PCI in a Type-B Hospital Nova Maryani; Gagah Buana Putra; Farhan Hanifati; Muhammad K. Abdillah
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2038

Abstract

Background: Delayed Percutaneous Coronary Intervention (PCI) remains common in resource-limited hospitals due to system-related delays, often resulting in prolonged ischemic time. Although early reperfusion is the standard of care for ST-segment Elevation Myocardial Infarction (STEMI), delayed PCI may still be performed in selected, clinically stable patients. This study aimed to evaluate the one-year incidence of Major Adverse Cardiac Events (MACE) among STEMI patients undergoing PCI in a Type-B hospital, where delayed PCI was the predominant treatment pattern. Methods: This retrospective cohort study included adult STEMI patients who underwent PCI at PKU Muhammadiyah Gamping Hospital, Yogyakarta, Indonesia, between September 2018 and December 2020. Patients with incomplete medical records or loss to follow-up were excluded. Baseline clinical characteristics, comorbidities, infarct location, and door-to-wire-crossing time were collected. MACE included all-cause mortality, acute pulmonary edema, non-ST-segment elevation myocardial infarction, stroke, and rehospitalization due to reinfarction or acute heart failure within one year after PCI. Kaplan-Meier survival analysis and Mann-Whitney testing were applied. Results: Among 130 STEMI patients who underwent PCI, 123 (94.6%) received delayed PCI, with a median door-to-wire-crossing time of 10 hours 34 minutes. During one-year follow-up, MACE occurred in 10 patients (7.7%), corresponding to a 92.3% event-free survival rate. No significant association was observed between door-to-wire-crossing time and one-year MACE (p = 0.927). Conclusions: In this single-center study conducted at a Type-B hospital, one-year MACE occurred in 7.7% of STEMI patients undergoing PCI, most of whom received delayed PCI. No significant association was observed between door-to-wire-crossing time and MACE occurrence. Given the observational design and the limited number of events, these findings should be interpreted with caution. Delayed PCI appears feasible in selected patients, but should not be considered equivalent to guideline-recommended early PCI.

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