FAKTOR PROGNOSTIK KADAR SOLUBLE ST2 SERUM TERHADAP KEJADIAN KARDIOVASKULAR MAYOR DALAM 90 HARI PADA PASIEN INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST YANG MENJALANI TERAPI REPERFUSI

PAMRAYOGI HUTOMO, Prof.Dr.dr. Budi Yuli Setianto, SpPD(K), SpJP(K).; Dr.Med.dr. Putrika Prastuti Ratna Gharini, SpJP(K)

2017 | Tesis-Spesialis | SP KARDIOLOGI DAN KEDOKTERAN VASKULAR

Latar Belakang: Kematian dan gagal jantung merupakan komplikasi yang sering terjadi pada infark miokard akut dengan elevasi segmen ST (IMA-EST). Pada fase awal IMA-EST seringkali gejala dan tanda klinis gagal jantung belum muncul, meskipun proses regangan ventrikel kiri telah terjadi. Pada fase lanjut, proses regangan ventrikel kiri akan tetap berjalan dan terjadi remodelling ventrikel berkelanjutan beserta komplikasinya. Biomarka sST2 dilepaskan oleh miokard yang mengalami regangan. Kadar sST2 fase awal yang tinggi telah terbukti sebagai prediktor mortalitas dan gagal jantung pada pasien IMA-EST dalam 30 hari dan dalam 1 tahun, namun pengaruhnya terhadap kejadian jangka menengah belum banyak diteliti. Studi ini bertujuan untuk menilai faktor prognostik kadar sST2 saat admisi dengan kejadian kardiovaskular mayor (KKM) berupa kematian dan gagal jantung akibat disfungsi ventrikel kiri dalam 90 hari pengamatan. Metode Penelitian: Penelitian kohort retrospektif dilakukan terhadap pasien IMA-EST dengan awitan 24 jam yang menjalani terapi reperfusi mulai April 2014 - Juni 2015. Sampel sST2 dari darah vena dilakukan pada saat admisi. Pasien dinilai munculnya KKM dalam 90 hari pasca IMA-EST berdasarkan data rekam medis. Analisis bivariat dilakukan terhadap faktor demografi dan klinis yang berhubungan dengan sST2 dan KKM. Analisis multivariat lalu dilakukan untuk mengetahui faktor independen yang mempengaruhi munculnya KKM. Hasil: Dari 107 pasien yang memenuhi kriteria subjek penelitian, terdapat 33 (30,8%) subjek dengan KKM dan 74 subjek (69,2%) tanpa KKM selama 90 hari pengamatan. Dari 33 subjek dengan KKM, terdapat 10 subjek (9,3%) meninggal dan 23 subjek (21,5%) dengan gagal jantung. Kadar sST2 tidak memiliki hubungan yang signifikan dengan mortalitas (p=0,617), kejadian gagal jantung (p=1,000), maupun gabungan keduanya (p=1,000) dalam 90 hari. Simpulan: Kadar sST2 serum yang tinggi saat admisi pada pasien IMA-EST yang telah menjalani terapi reperfusi tidak berhubungan dengan meningkatnya insidensi KKM (baik mortalitas atau kejadian gagal jantung saja maupun gabungan keduanya) selama 90 hari pengamatan pasca IMA-EST.

Background: Mortality and heart failure are common complications of ST elevation myocardial infarction (STEMI). In the early stages of STEMI, symptoms and clinical signs of heart failure have not yet emerged, although the left ventricular strain process has occurred. In the subsequent stage, the left ventricular strain process will continue to happen and ventricular remodeling with its complications begin to emerges. Soluble ST2 (sST2) is released by strained myocardial. High baseline sST2 levels have been shown to be a predictor of mortality and heart failure in IMA-EST patients within 30 days and within 1 year, but its effect on medium-term events has not been widely investigated. This study aims to assess the prognostic factor of sST2 levels during admission with major cardiovascular events in the form of death and heart failure due to left ventricular dysfunction within 90 days of observation. Methods: A retrospective cohort study was conducted on IMA-EST patients with an onset of 24 hours undergoing reperfusion therapy from April 2014 - June 2015. The sST2 sample of venous blood was performed at admission. Assessment of major cardiovascular events within 90 days after infarct was based on medical record data. Bivariate analysis were conducted on demographic and clinical factors related to sST2 and major cardiovascular events. A multivariate analysis was then conducted to determine the independent factors that influenced the emergence of major cardiovascular events. Results: Of the 107 patients who met the subject criteria, there were 33 (30.8%) subjects with major cardiovascular events and 74 subjects (69.2%) without major cardiovascular events in 90 days of observation. Of the 33 subjects with major cardiovascular events, there were 10 subjects (9.3%) died and 23 subjects (21.5%) with heart failure. The sST2 levels did not have a significant relationship with the incidence of mortality (p=0.617), heart failure (p=1,000), or both combined (p = 1,000) in 90 days of observation. Conclusion: High serum sST2 levels during admission in STEMI patients who had undergone reperfusion therapy were not associated with increased incidence of major cardiovascular events (either the incidence of mortality or heart failure alone or both combined) in 90 days observation.

Kata Kunci : IMA-EST, soluble ST2, kejadian kardiovaskular mayor, mortalitas, gagal jantung, STEMI, soluble ST2, major cardiovascular events, mortality, heart failure