KADAR SOLUBLE SUPPRESSION OF TUMORIGENICITY 2 (sST2) SEBAGAI PREDIKTOR MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE) PADA PASIEN INFARK MIOKARD AKUT

INDAH SUKMASARI, Dr. Med. dr. Suwarso, Sp.PK (K).; dr. Windarwati, Sp.PK(K)

2017 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Latar belakang: Infark miokard akut mempunyai potensi meningkatkan morbiditas dan mortalitas pasca infark. Protein soluble ST2 (sST2) disekresikan oleh miokard yang mengalami regangan mekanis akibat injuri atau infark miokard pada dinding ventrikel kiri. Sekresi sST2 dalam sirkulasi menyebabkan hambatan kardioproteksi sistem IL33 sehingga memperburuk disfungsi ventrikel kiri dan munculnya kejadian major adverse cardiovascular event (MACE) selama fase akut IMA. Tujuan: Penelitian ini bertujuan untuk membuktikan peranan tingginya kadar sST2 saat admisi terhadap munculnya MACE yaitu kematian, gagal jantung akut, syok kardiogenik dan aritmia ventrikel pada 7 hari perawatan pasien IMA di rumah sakit.. Metode: Penelitian ini merupakan penelitian observasional dengan desain penelitian kohort. Subjek adalah pasien yang didiagnosis dengan IMA dan dirawat di Instalasi Rawat Jantung (ICCU) RSUP Dr. Sardjito. Kadar sST2 diukur dengan metode POCT 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 +- 35 ng/mL dan sST2 < 35 ng/mL. Subjek diamati selama 7 hari perawatan di RS dan dinilai munculnya MACE. Hasil: Subjek penelitian ini sebanyak 56 pasien, sebanyak 28 subjek masuk dalam kelompok sST2 +- 35 ng/mL dan 28 subjek dalam kelompok sST2 < 35 ng/mL. Selama pengamatan, MACE dialami oleh 18 subjek (32,14 %). Nilai median subjek yang mengalami MACE 80,9 (25,1- 249,86) ng/mL berbeda bermakna dengan kadar sST2 pada subjek yang tidak mengalami MACE 21,8 (14,5-248,86) ng/mL dengan p = < 0,001. Kadar sST2 +- 35 ng/mL mempunyai kecenderungan meningkatkan risiko MACE dengan RR=3,99 (p= 0,022; 95% CI: 1,18 - 13,49) Kesimpulan: Pasien IMA dengan kadar sST2 +- 35 ng/mL saat admisi secara bermakna meningkatkan risiko kejadian MACE pada 7 hari perawatan di rumah sakit.

Background: Acute myocardial infarction (AMI) has a potency to increasing post infarct morbidity and mortality. 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 AMI. 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 AMI during 7 day hospitalised. Methods: The research was observational study with cohort design. Subjects were patients diagnosed with AMI and hospitalised in Dr. Sardjito Hospital. The level of sST2 is measured with point of care testing (POCT) methods from peripheral veins blood samples which is withdrawn on admission. Based on sST2 level, subject are divided into two groups, i.e. sST2 +- 35 ng/mL and sST2 < 35 ng/mL. Subject is observed during 7 day hospitalisation and evaluate the occurrence of MACE. Results: Subjects enrolled were 56 patients, as many as 28 subjects were sST2 +- 35 ng/mL group and 28 were sST2 < 35 ng/mL group. During observation, MACE occurred in 18 subjects (32,14 %). Median for sST2 significantly different between subject with and without MACE (80.9 ng/mL vs. 21.8 ng/mL) with p value = < 0,001. Soluble ST2 +- 35 ng/mL level has tendency increasing the risk of with RR 3.99 (p= 0.022; 95% CI: 1.18-13.49) Conclusion: Patients with AMI with level serum sST2 +- 35 ng/mL on admission significantly increase the risk to develop MACE during 7 day hospital care.

Kata Kunci : soluble ST2, infark miokard akut, major adverse cardiovascular event, perawatan/soluble ST2, acute myocardial infarction, major adverse cardiovascular events, hospitalization