PERBEDAAN KADAR D-DIMER SEBAGAI PENANDA TROMBOEMBOLI PADA PASIEN SINDROMA KORONER AKUT DI RSUP DR. SARDJITO YOGYAKARTA Kajian pada Pasien Unstable Angina Pectoris, Non ST Elevation Myocardial Infarction dan ST Elevation Myocardial Infarction

Ardian Yaputra Ng, dr. Usi Sukorini Mkes, Sp.PK-K,

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

Diagnosis Sindroma Koroner Akut (SKA) didapat dari gejala klinis, EKG dan marker jantung Troponin. Berdasarkan patofisiologi SKA, pada saat serangan akut, terjadi ruptur plak pembuluh darah koroner yang ditandai dengan meningkatnya pemecahan cross-linked fibrin seperti D-dimer. Dengan pemeriksaan kadar D-dimer dapat diketahui onset mulai terjadinya serangan akut iskemia sehingga tidak berkembang menjadi infark jantung. Penelitian ini bertujuan untuk menguji perbedaan kadar D-dimer pada pasien UAP, NSTEMI dan STEMI di RSUP Dr.Sardjito Yogyakarta dan mengetahui adanya korelasi antara kadar troponin I dengan D-dimer pada pasien NSTEMI dan STEMI. Penelitian ini merupakan studi cross sectional dengan subyek penderita baru UAP, NSTEMI dan STEMI di Instalasi Gawat Darurat (IGD) RSUP Dr Sardjito Yogyakarta, yang dipilih secara berurutan antara bulan Januari 2011 – April 2011. Pemeriksaan kadar D-dimer menggunakan metode sandwich Enzyme Linked Fluorescent Assay (ELFA). Data karakteristik subyek penelitian ditampilkan secara deskriptif analitik. Jumlah pasien sebanyak 60 subyek, dibagi atas 3 kelompok dengan masingmasing yang terdiri dari 20 subyek. Dengan uji Kruskal Wallis, didapatkan perbedaan bermakna kadar D-dimer antara kelompok UAP (Unstable Angina Pectoris), NSTEMI (Non ST Elevation Myocardial Infarction) dan STEMI (ST Elevation Myocardial Infarction) dengan p=0,001. Kadar median D-dimer kelompok UAP, NSTEMI dan STEMI masing-masing sebesar 751,72 ng/ml; 1198,95 ng/ml dan 1781,37 ng/ml. Kadar D-dimer antara kelompok UAP dengan NSTEMI didapatkan perbedaan bermakna dengan p=0,001, antara kelompok UAP dengan STEMI dengan p=0,001 sedangkan antara kelompok NSTEMI dan STEMI tidak didapatkan perbedaan bermakna dengan p=0,086. Uji korelasi Spearman antara Troponin I dan D-dimer didapatkan adanya korelasi positif sedang dengan r=0,543;p=0,013 pada kelompok NSTEMI dan r=0,511;p=0,021 pada kelompok STEMI. Pada penelitian ini didapatkan 2 subyek penelitian kelompok NSTEMI dengan kadar Troponin I yang terukur normal pada awal masuk RSUP Sardjito tetapi kadar D-dimer mencapai 995,2 ng/ml dan 1151,86 ng/ml.

Diagnosis of acute coronary syndromes (ACS), obtained from clinical symptoms, ECG and cardiac marker Troponin. Based on the pathophysiology of ACS, at the time of acute attack, there was a coronary artery plaque rupture is marked by increasing a cross-linked fibrin like a D-dimer. By examination of D-dimer levels can be known the onset of acute ischemic attack so it does not develop into cardiac infarction. This study aims to determine the differences Ddimer levels in patients with UAP, NSTEMI and STEMI in Dr.Sardjito General Hospital Yogyakarta and to aware of any correlation between levels of troponin I with the D-dimer in patients with NSTEMI and STEMI. This study is a cross sectional study with subjects UAP, NSTEMI and STEMI patients in the Emergency Room Dr.Sardjito General Hospital Yogyakarta, which is selected by consecutive between January 2011 - April 2011. Examination D-dimer levels using a sandwich Enzyme Linked Fluorescent Assay (ELFA). Data characteristics of study subjects displayed a descriptive analytic. The number of patients of 60 subjects, divided into 3 groups with each consisting of 20 subjects. With the Kruskal Wallis test, found significant differences of D-dimer levels between groups of UAP (Unstable Angina pectoris), NSTEMI (Non ST Elevation Myocardial Infarction) and STEMI (ST Elevation Myocardial Infarction) with p = 0.001. Median levels of D-dimer in group UAP, NSTEMI and STEMI, respectively 751.72 ng / ml; 1198.95 ng / ml and 1781.37 ng / ml. Ddimer levels between the UAP group with NSTEMI found significant differences with p = 0.001, between groups of UAP with STEMI with p = 0.001, while between NSTEMI and STEMI groups found no significant difference with p = 0.086. Spearman correlation test between Troponin I and D-dimer obtained a positive correlation with r = 0.543, p = 0.013 in the NSTEMI group and r = 0.511, p = 0.021 in the STEMI group. In this study found two groups of research subjects with NSTEMI troponin I levels are normally measured on initial admission Sardjito General Hospital, but D-dimer levels reached 995.2 ng / ml and 1151.86 ng/ml.

Kata Kunci : Sindroma Koroner Akut, D-dimer, Unstable angina, NSTEMI, STEMI