Penambahan Skor Kalsium Sebagai Nilai Diagnostik pada Kriteria Duke Treadmill Score Sedang untuk Mendeteksi Keparahan Lesi Koroner pada Pasien Terduga Penyakit Jantung Koroner Stabil

Nida Atmim Suyani, dr. Irsad Andi Arso, M.Sc, SpPD(K), Sp.JP(K); dr. Arditya Damar Kusuma, M.Med (ClinEpi), SpJP, Subsp.K.I.(K)

2026 | Tesis-Spesialis | ILMU PENYAKIT JANTUNG DAN PEMBULUH DARAH

Latar Belakang: Uji latih jantung (ULJ) merupakan salah satu pemeriksaan awal pada pasien terduga penyakit jantung koroner (PJK) stabil. Hasil ULJ dapat dinilai menggunakan Duke Treadmill Score (DTS) dalam melakukan stratifikasi risiko. Namun, DTS risiko sedang masih menjadi kelompok abu-abu dalam mendeteksi koroner berat. Skor kalsium dapat membantu reklasifikasi risiko berdasarkan pedoman ESC.  

Tujuan: Penelitian ini bertujuan mengetahui nilai diagnostik penambahan skor kalsium pada kriteria DTS risiko sedang dalam mendeteksi keparahan lesi koroner berdasarkan skor SYNTAX pada pasien dengan dugaan penyakit jantung koroner stabil. 

Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang, yang dilakukan di RSUP Dr. Sardjito Yogyakarta pada periode Januari 2023 hingga Mei 2026. Subjek penelitian adalah pasien terduga PJK stabil dengan hasil ULJ positif dan DTS risiko sedang yang menjalani pemeriksaan skor kalsium serta angiografi koroner. Keparahan lesi koroner dinilai berdasarkan skor SYNTAX dari angiografi koroner invasif. Analisis dilakukan menggunakan uji bivariat, regresi logistik multivariat, uji diagnostik, dan kurva ROC. 

Hasil: Sebanyak 85 subjek dianalisis. Median usia subjek adalah 60 tahun, dan 66 subjek (77,6%) berjenis kelamin laki-laki. Pada kelompok dengan skor SYNTAX tinggi, median skor kalsium lebih tinggi secara bermakna dibandingkan kelompok SYNTAX rendah (p <0 p=0,003,>= 4,369). Pada uji diagnostik, skor kalsium > 400 memiliki sensitivitas 69,23%, spesifisitas 65,22%, nilai ramal positif 62,79%, nilai ramal negatif 71,43%, dan akurasi 67,06%. Analisis ROC menunjukkan bahwa kombinasi DTS dan skor kalsium menghasilkan AUC tertinggi, yaitu 0,760.

Kesimpulan: Penambahan skor kalsium pada pasien dengan DTS risiko sedang memberikan nilai diagnostik moderate dibandingkan DTS saja dalam mendeteksi keparahan lesi koroner berat berdasarkan skor SYNTAX.  

Kata kunci: Duke Treadmill Score, skor kalsium koroner, skor SYNTAX, penyakit jantung koroner, keparahan lesi koroner

Background: Exercise stress testing is commonly used as an initial diagnostic assessment in patients with suspected stable coronary artery disease (CAD). Its findings can be interpreted using the Duke Treadmill Score (DTS) for risk stratification. However, patients with an intermediate-risk DTS remain in a diagnostic grey zone for identifying severe coronary lesions. Coronary artery calcium scoring may provide clinically useful additional information and support risk reclassification.

Objective: This study aimed to evaluate the diagnostic value of adding coronary artery calcium scoring to an intermediate-risk DTS for detecting severe coronary lesions based on the SYNTAX score in patients with suspected stable CAD.

Methods: This analytical observational study used a cross-sectional design and was conducted at Dr. Sardjito General Hospital, Yogyakarta, from January 2023 to May 2026. Patients with suspected stable CAD, a positive exercise stress test, and an intermediate-risk DTS who underwent coronary artery calcium scoring and invasive coronary angiography were included. Statistical analyses included bivariate analysis, multivariable logistic regression, diagnostic accuracy testing, and receiver operating characteristic curve analysis.

Results: A total of 85 patients were analysed. The median age was 60 years, and 66 patients (77.6%) were male. The median coronary artery calcium score was significantly higher in the high SYNTAX score group than in the low SYNTAX score group (p<0>400 was independently associated with a high SYNTAX score (OR 4.369; 95% CI 1.668–11.442; p=0.003). A coronary artery calcium score >400 showed a sensitivity of 69.23%, specificity of 65.22%, positive predictive value of 62.79%, negative predictive value of 71.43%, and overall accuracy of 67.06%. Receiver operating characteristic analysis showed that the combination of DTS and coronary artery calcium score produced the highest area under the curve, at 0.760.

Conclusion: Adding coronary artery calcium scoring to the evaluation of patients with an intermediate-risk DTS provided moderate diagnostic performance and improved the identification of severe coronary lesions based on the SYNTAX score compared with the DTS alone.

Keywords: coronary artery calcium score, coronary artery disease, Duke Treadmill Score, severe coronary lesions, SYNTAX score.

Kata Kunci : Duke Treadmill Score, skor kalsium koroner, skor SYNTAX, penyakit jantung koroner, keparahan lesi koroner