Hubungan kadar gula darah saat masuk rumah sakit dengan Cardiac events pada penderita infark miokard akut di Rumah Sakit Dr. Sardjito Yogyakarta

SUHARNO, dr. Bambang Irawan, SpPD-KKV.,SpJP-FIHA

2005 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang : Hiperglikemia sering terjadi pada infark miokard akut dengan atau tanpa diabetes mellitus. Terdapat hubungan yang positif antara hiperglikemia yang menyertai infark miokard akut dengan tingginya mortalitas dan morbiditas. Karenanya sangat penting memahami mekanisme perburukan prognosis serta efektivitas pengendalian hiperglikemia yang menyertai infark miokard. Tujuan penelitian : Mengetahui hubungan antara kadar gula darah saat masuk rumah sakit dengan cardiac events pada penderita infark miokard akut non diabetik Metode / cara penelitian : Penelitian dilakukan secara kohort prospektif observasional pada penderita IMA yang dirawat di ICCU RS Dr. Sardjito mulai dari bulan Maret 2002 sampai Oktober 2004 dan dilakukan follow up selama 6 bulan. Subyek yang memenuhi kriteria inklusi dan eksklusi dibagi menjadi dua kelompok, yaitu kelompok yang memiliki kadar gula darah sewaktu saat masuk rumah sakit < 140 mg /dl dan kelompok yang memiliki gula darah random > 140 mg/dl. Selama 6 bulan dilakukan follow up diobservasi kejadian cardiac events seperti kematian, gagal jantung, syok kardiogenik dan reinfark. Hasil : Didapatkan subyek sebanyak 95 orang, yang terdiri dari 93 orang laki-laki dan 2 orang perempuan. Kelompok dengan gula daerah sewaktu < 140 mg /dl 47 orang, sedangkan gula darah sewaktu > 140 mg /dl 48 orang. Cardiac events pada kelompok dengan gula darah sewaktu > 140 mg/dl lebih tinggi dibandingkan dengan kelompok gula darah random < 140 mg/dl. Namun demikian dengan analisis survival Kaplan–Meier ,hanya gagal jantung dan kematian yang bermakna secara statistik dengan p Log rank masing-masing adalah 0,0193 dan 0 ,0084. Kesimpulan : Cardiac events selama follow up 6 bulan pada penderita infark miokard akut dengan hiperglikemia lebih tinggi dibandingkan dengan tanpa hiperglikemia.

Backgroud : Hyperglycaemia is common in patients with acute myocardial infarction with and without diabetes mellitus. There is positif association between hyperglycaemia at the time of event and highly incidence of mortality and morbidity after AMI. Consequently, understanding the possible mechanisms through which hyperglycaemia worsens the prognosis of AMI, as well the effectiveness of its control during AMI, seems to be a great relevance Objective : To investigate wether a relationship exists between blood glucose level on admission and cardiac events in non diabetic patients after an acute myocardial infarction. Methode : A cohort prospective observational study was done on acute myocardial infarction patients who were hospitalized in the ICCU Dr. Sardjito hospital from March 2002 untill October 2004. Subject who met inclusion and exclution criterias were divided into 2 groups, blood glucose on admission < 140 mg/dl group and > 140 mg/dl group. Cardiac events like mortality, cardiac failure, reinfarction and cardiogenic shock were observed for 6 months. Result : There were 95 subjects , 93 males and 2 females. Subjects were divided into 2 groups based on blood glucose level on admission. 48 subjects in group with blood glucose on admission > 140 mg/dl and 47 subjects with blood glucose on admission < 140 mg/dl. The incidency of cardiac event were higher in group with hyperglycaemia than group without hyperglycaemia. However, survival analysis showed only cardiac failure and mortality were statistically significant with Log rank test p, consecutively = 0,0192 and 0,0084. Conclusion : Cardiac events during 6 months follow up after an acute myocardial infarction with hyperglycaemia higher than without hyperglycaemia. Eventhough, only cardiac failure and mortality which are statistically significant with blood glucose on admission following acute myocardial infarction.

Kata Kunci : Infark Miokart Akut, Cardiac Events, Kadar Gula, blood glucose on admission – acute myocardial infarction – cardiac events.