PENGARUH KADAR SOLUBLE ST2 SERUM TERHADAP RISIKO KEJADIAN KARDIOVASKULAR MAYOR SELAMA PERAWATAN INTENSIF PADA INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN-ST

ANGGORO BUDI HARTOPO, Dr. dr. Budi Yuli Setianto, Sp.PD(K), Sp.JP(K).; dr. Nahar Taufiq, Sp.JP(K)

2016 | Tesis-Spesialis | SP KARDIOLOGI DAN KEDOKTERAN VASKULAR

Latar belakang: Infark miokard akut dengan elevasi segmen-ST (IMA-EST)mempunyai potensi meningkatkan morbiditas dan mortalitas pasca infark. Pada IMAEST, infark transmural menyebabkan area miokardia yang mengalami cedera maupun yang sehat, mengalami peregangan. Protein soluble ST2 (sST2)disekresikan oleh miokardia yang mengalami regangan mekanis akibat injuri atau infark miokard pada dinding ventrikel kiri. Sekresi sST2 dalam sirkulasi menyebabkan hambatan kardioproteksi sistem ST2 sehingga memperburuk disfungsi ventrikel kiri dan munculnya kejadian kardiovaskular mayor (KKM)selama fase akut IMA-EST. Tujuan: Penelitian ini bertujuan untuk membuktikan peranan tingginya kadar sST2 saat admisi terhadap munculnya KKM, yaitu kematian, gagal jantung akut, syok kardiogenik dan aritmia ventrikel yang memerlukan resusitasi, pada pasien IMA-EST yang dirawat secara intensif. Metode: Penelitian ini merupakan penelitian observasional dengan disain penelitian kohort. Subjek adalah pasien yang didiagnosis dengan IMA-EST dan dirawat di Instalasi Rawat Jantung (ICCU)RSUP Dr. Sardjito. Kadar sST2 diukur dengan metode ELISA dari sampel darah vena perifer yang diambil pada saat subjek masuk admisi. Berdasarkan kadar sST2 subjek dibagi dalam dua kelompok yaitu subjek dengan kadar sST2 supramedian dan sST2 inframedian. Subjek diamati selama perawatan intensif di ICCU dan dinilai munculnya KKM. Hasil: Subjek penelitian ini sebanyak 143 pasien, dengan nilai rerata dan simpang baku kadar sST2 740,79 pg/mL dan median 751,16 pg/mL. Sebanyak 72 subjek masuk dalam kelompok sST2 inframedian dan 71 subjek dalam kelompok sST2 supramedian. Selama pengamatan, KKM dialami 25 subjek (17,5 %). Nilai rerata dan simpang baku kadar sST2 tidak berbeda bermakna antara subjek yang mengalami KKM dan tidak mengalami KKM (747,7 pg/mL+-115,4 pg/mL v.s. 739,3 pg/mL+-123,7 pg/mL). Proporsi subjek yang mengalami KKM cenderung lebih tinggi pada subjek sST2 supramedian (21,1 %) dibandingkan subjek sST2 inframedian (13,9 %), namun tidak berbeda secara statistik (p = 0,25). Kadar sST2 supramedian mempunyai kecenderungan meningkatkan risiko KKM sebesar 1,37, namun tidak bermakna secara statistik. Kesimpulan: Pasien IMA-EST dengan kadar sST2 serum yang tinggi pada pengukuran saat admisi tidak secara bermakna meningkatkan risiko kejadian kardiovaskular mayor selama perawatan intensif di rumah sakit.

Background: ST-elevation acute myocardial infarction (STEMI)has a potency to increasing post infarct morbidity and mortality. In STEMI, transmural infarct cause myocardial area which is injured and healthy undergone straining. Solube ST2 (sST2)protein is secreted by straining myocardia due to injury or infarct in the left ventricle. The secretion of sST2 in circulation reduce ST2-mediated cardioprotection system, therefore deteriorate left ventricle dysfunction and increased the incidence of major adverse cardiovascular events (MACE) during acute phase of STEMI. Aims: The aim of this research is to investigate whether the higher level of sST2 on admission associate with the occurrence of MACE, i.e. death, acute heart failure, cardiogenic shock and ventricular arrhytmia needed rescucitation, in patients with STEMI undergoing intensive hospitalisation. Methods: The research is observational study with cohort design. Subjects are patients diagnosed with STEMI and hospitalised in ICCU of Dr. Sardjito Hospital. The level of sST2 is measured with ELISA methods from peripheral veins blood samples which is withdrawn on admission. Based on sST2 level, subject are divided into two groups, i.e. supramedian sST2 and inframedian sST2. Subject is observed during intensive hospitalisation in ICCU and evaluate the occurrence of MACE. Results: Subjects enrolled are 143 patients, with sST2 means 740,79 pg/mL and median 751,16 pg/mL. As many as 72 subjects are inframedian sST2 group and 71 are supramedian sST2 group. During observation, MACE occurred in 25 subjects (17.5 %). Means and standard deviation for sST2 do not significantly different between subject with and without MACE (747,7 pg/mL+-115,4 pg/mL v.s. 739,3 pg/mL+-123,7 pg/mL). The proportion of subject with MACE tends to be higher in sST2 supramedian (21.1 %)as compared to sST2 inframedian (13.9 %), but not significant. sST2 supramedian level has tendency increasing the risk of MACE 1.37 time, however the risk does not statistically significant. Conclusion: Patients with STEMI with higher serum sST2 on admission do not significantly increase the risk to develop MACE during intensive hospitalisation.

Kata Kunci : soluble ST2, ST elevation acute myocardial infarction, major adverse cardiovascular events, intensive hospitalisation.