PROFIL SERUM AMYLOID A PADA PASIEN SINDROM KORONER AKUT DI RSUP DR. SARDJITO YOGYAKARTA Kajian pada Pasien Unstable Angina Pectoris, Non- ST Elevation Myocardial Infarction dan ST Elevation Myocardial Infarction

Yusnitasari, dr. Setyawati, Sp-PK(K)

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar Belakang: Sindrom koroner akut merupakan masalah kesehatan utama, dan salah satu penyebab kematian didunia. Hampir sepertiga dari seluruh kematian di dunia tahun 2001 adalah penyakit kardiovaskuler. Diperkirakan pada tahun 2020, setiap tahunnya akan terdapat 25 juta kematian akibat penyakit kardiovaskuler dan hampir separuhnya akibat penyakit jantung koroner. Protein serum amyloid A (SAA) merupakan protein fase akut yang dihasilkan hepar, sebagai respon terhadap stimuli inflamatorik akut dan kronis dan kadarnya dapat meningkat hingga mencapai 1000 kali lipat. Serum Amyloid A menurunkan kinerja HDL dengan berperan sebagai protein utama HDL menggantikan Apo A-1. Tujuan penelitian ini untuk mengetahui perbedaan kadar serum amyloid A pada pasien UAP, NSTEMI dan STEMI di RSUP Dr. Sardjito Yogyakarta. Metode penelitian dan analisis data: cross sectional, subyek penelitian 60 diambil secara konsekutif di RSUP. DR. Sardjito, Yogyakarta yaitu penderita UAP, NSTEMI dan STEMI yang terbukti secara EKG dan pemeriksaan enzim jantung. SAA diukur dengan metode sandwich ELISA. Dilakukan uji rerata kadar SAA pada kelompok UAP, NSTEMI dan STEMI. Uji beda rerata dilakukan dengan t-test atau Mann-Whitney dan ANOVA atau Kruskall Wallis. Perhitungan statistik menggunakan batas kemaknaan p<0,05 Hasil: Terdapat perbedaan signifikan median kadar SAA pada pasien UAP (77,47 ng/mL) dengan NSTEMI (123,29 ng/mL), p=0,001 dan UAP dengan STEMI (131,12 ng/mL), p=0,001. Tetapi tidak terdapat perbedaan bermakna antara NSTEMI dan STEMI dimana p=0.056. Adanya korelasi antara SAA dengan troponin I pada NSTEMI (r=0,482, p=0.032) dan STEMI (r=0,568, p=0,009). Terdapat 2 subyek NSTEMI dengan troponin I normal (<0.1ng/ml) saat masuk IGD tetapi kadar SAA terukur tinggi yaitu 118.40 dan 112.76 ng/mL. Pada pemeriksaan troponin I kedua, didapatkan peningkatan troponin I sebesar 1.02 dan 0.18 ng/mL berturut-turut. Simpulan: Terdapat perbedaan yang bermakna antara kelompok UAP dengan kelompok pasien STEMI dan NSTEMI dimana p=0,001. Kadar SAA memiliki korelasi positif moderat dengan kadar troponin I pada pasien yang datang ke IGD dengan SKA.

Background: Acute coronary syndrome is a major health problem, and one of the most common cause of mortality worldwide, as approximately one third of all death in 2001 was caused by cardiovascular disease. It is estimated that in 2020, there will be 25 millions of death annually as the result of cardiovascular disease and almost half of will be caused by coronary heart disease. Serum amyloid A (SAA) protein is an acute phase protein that is produced by the liver, in response to acute and chronic inflammatory stimuli and its level can reach as high as 1000 fold. Serum Amyloid A attenuate HDL performance by replacing Apo A1 as the major protein of HDL. Objective : to assess the level of serum amyloid A level in patients with UAP and NSTEMI and STEMI in Dr. Sardjito Hospital Yogyakarta. Method: This is a cross sectional study, with as many as 60 subjects will be entered in the study from Dr. Sardjito Hospital, Yogyakarta. These subjects are the patients with UAP, NSTEMI and STEMI, with documented electrocardiography and cardiac enzyme measurement. Meanwhile, SAA will be measured with sandwich ELISA method. The subject’s characteristic data will be presented as the result from descriptive analysis. The mean of SAA level in UAP, NSTEMI and STEMI will be compared. The difference of means will tested with t- or Mann-Whitney and ANOVA or Kruskall Wallis with significance level of p<0,05 and 95% confidence interval. Result: There are significance differences in median SAA levels between UAP (77.47 ng/mL) and NSTEMI patients (123.29 ng/mL), in which p = 0.001 and between UAP with STEMI patients (131.12 ng/mL) and p = 0.001. But not significance differences in median SAA levels between NSTEMI and STEMI, in which p=0.056. There was a moderate correlation between SAA level and troponin I in NSTEMI (r=0.482, p=0.032) and STEMI patients (r=0.568, p=0.009). There were two subjects of NSTEMI with normal troponin I levels (<0,1ng/mL) at ER admission but high SAA levels, 118.40 and 112,76 ng/mL, respectively. At the second measurement of troponin I, we found elevated troponin I levels by 1.02 and 0.18ng/mL, respectively. Conclusion: There is significant differences in SAA levels between UAP with NSTEMI patients and UAP with STEMI patients, in which p=0.001. Positive correlation was found between SAA and troponin I in NSTEMI and STEMI.

Kata Kunci : Nyeri dada, STEMI, NSTEMI, serum amyloid A, unstable angina pectoris.