Pemakaian Kadar HbA1c sebagai Faktor Prediksi Luaran Buruk pada Pasien Infark Miokard Akut Tanpa Elevasi Segmen ST

MICHAEL ALVIAN, dr.Anggoro Budi Hartopo, M.Sc, Sp.PD,Ph.D; dr. Vita Yanti Anggraeni, M.Sc, Sp.PD,Ph.D

2016 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang : Kejadian infark miokard akut terkhusus tanpa elevasi segmen ST mengalami peningkatan yang signifikan belakangan ini walaupun tingkat keparahannya jauh lebih rendah dibandingkan pasien dengan elevasi segmen ST. Pasien IMA Non EST yang datang pada umumnya tidak mengetahui seputar penyakit diabetes melitusnya. Padahal, penyakit DM diketahui memiliki luaran buruk makrovaskular pada jantung. ADA merekomendasikan pemeriksaan HbA1c sebagai salah satu kriteria diagnosis DM pada tahun 2011. Secara teoritis, HbA1c dapat dipakai untuk memprediksi luaran buruk pasien IMA Non EST, namun terkait hubungan HbA1c dengan luaran buruk pada jantung masih perlu dikaji penelitiannya lebih lanjut. Tujuan : Mencari hubungan kadar HbA1c dengan luaran buruk kardiovaskular pada pasien IMA Non EST selama dilakukan perawatan intensif. Metode : Penelitian dilakukan dengan metode cohort retrospektif dengan melibatkan 43 pasien IMA Non EST yang dirawat di ICCU RSUP Dr. Sardjito. yang dipilih sesuai kriteria inklusi dan eksklusi secara berturutan. Kadar HbA1c diukur pada saat pasien tiba di ICCU dan diukur dengan metode immunoturbidimetrik. Pasien kemudian dibagi menjadi 2 kelompok berdasarkan kadar HbA1c pasien dimana kadar HbA1c sebesar 6,5 ditetapkan sebagai cut-off. Proporsi kemudian dianalisis dengan uji X2. Hasil : Hasil uji X2 menunjukan hasil yang signifikan antara peningkatan kadar HbA1c yang meningkatkan luaran buruk kardiovaskular (MACE) dengan nilai p sebesar 0,024. Pasien dengan IMA Non EST yang memiliki kadar HbA1c < 6,5 memiliki risiko sebesar 9,23 kali lebih kecil untuk memiliki luaran buruk kardiovaskular selama dilakukan perawatan intensif. Kesimpulan : Semakin tinggi kadar HbA1c selama perawatan intensif di ICCU akan semakin meningkatkan jumlah pasien dengan luaran buruk kardiovaskular (MACE).

Background : Acute myocardial infarction especially those with NSTEMI having a significant rise lately, although the severity of the disease is much better than those patient with STEMI. Patient with NSTEMI who come to the hospital usually don't know everything regarding the diagnostic status of having diabetes melitus. As far as our concerned, diabetes Melitus itself known to have a bad outcome and macrovascular impact directly to the heart.The American Diabetes Association recommended the examination of HbA1c as one of many criterias needed to diagnose DM in year 2011. Theoretically speaking, HbA1c could be used to predict the adverse event of those diagnosed with NSTEMI, but about the relation between HbA1c level with MACE should be done in a further research. Objective : To find the relationship between HbA1c level with MACE in patient which diagnosed as having NSTEMI while on intensive care. Method : The research's design is cohort retrospective study, which recruit 43 patients which are diagnosed of having NSTEMI under intensive care in ICCU RSUP Dr. Sardjito. All the research subjects are chosen consecutively and based on those who meet certain inclusion and exclusion criterias. HbA1c level is measured on admission and by immunoturbidimetric method. Afterwards, all the research subjects are classified into 2 groups based on their HbA1c level in which HbA1c level of 6.5 is denoted as the cut-off point. The proportion are analyzed by using statistical Chi Square Method (X2). Result : The statistical X2 test result indicated a significancy in which the rise of HbA1c level will also trigger a major cardiovascular event rise, it's proven by the p-value of 0.024. Subjects with NSTEMI level below 6.5 will have a risk of about 9.23 times lower to have MACE under intensive care. Conclusion : The higher the level of HbA1c of the subjects under intensive care in ICCU will increase the number of subjects with NSTEMI having major adverse cardiovascular events.

Kata Kunci : IMA Non EST, HbA1c, Luaran buruk kardiovaskular (MACE), Diabetes Melitus, rawat jantung intensif/ Non ST Elevation Myocardial Infarction (NSTEMI), HbA1c, Major Adverse Cardiovascular Event (MACE), Diabetes melitus, Intensive cardiac care.