HUBUNGAN KADAR SERUM MATRIX METALLOPROTEINASE-9 TERHADAP KEJADIAN GAGAL JANTUNG AKUT SEBAGAI KOMPLIKASI SINDROMA KORONER AKUT

Sasongko Hadipurnomo, dr, dr. Budi Yuli Setianto, SpPD-KKV, SpJP(K),

2012 | Tesis | S2 Ked.Klinik/MS-PPDS

Gagal jantung akut paska SKA merupakan komplikasi terbesar dan mempunyai prognosis yang buruk dalam jangka panjang. Peran MMP-9 sebagai enzim perusak matrik ekstraseluler, dalam remodeling ventrikel kiri telah diketahui tetapi evaluasi prediktor MMP-9 terhadap gagal jantung akut paska SKA sepengetahuan penulis belum pernah dilaporkan. Tujuan: Mengetahui kadar serum MMP-9 pada SKA yang mengalami gagal jantung akut lebih tinggi dari pada yang tidak. Tujuan lainnya aikan kadar MMP- 9 berisiko terjadinya gagal jantung akut paska SKA. Metode: Desain penelitian adalah cross sectional study. Pengambilan sampel dilakukan secara berurutan (consecutive sampling) dari pasien SKA yang dirawat di bagian ICCU RSUP Dr Sardjito Yogyakarta, sejak Juni 2008 sampai Agustus 2010. Digunakan kuisioner untuk mengumpulkan data dasar sampel. Kadar MMP-9 diperiksa1 kali saat masuk di UGD/ ICCU sebelum dilakukan trombolisis. Gagal jantung dengan skor Killip II- IV. Faktor yang berpengaruh dilakukan analisis multivariat. Angka kemaknaan adalah p< 0.05. Risiko relatif kejadian gagal jantung akut pada kadar MMP-9 tertentu (dari nilai cut-off) didapat setelah dilakukan adjusted. Hasil: Terdapat 122 subjek, terdapat 75 subjek tanpa gagal jantung akut dan 47 dengan gagal jantung akut. Kadar MMP-9 pada seluruh sampel SKA adalah median sebesar 1248,55 ng/mL, minimum 170,50 ng/mL maksimum 3058,40 ng/mL, kadar MMP-9 pada SKA yang mengalami gagal jantung akut (1700,81±740,43 ng/mL) dan signifikan lebih tinggi dari pada SKA yang tidak mengalami gagal jantung akut (1189,55±654,60 ng/mL) dengan nilai p = 0,000. Faktor risiko independen setelah dilakukan multivariat adalah kadar MMP-9 diatas 1444 ng/mL (RR= 4,2) dan lokasi infark anterior (RR= 2,9). Kesimpulan: Pada pasien SKA yang dirawat di ICCU RSUP Dr Sardjito, kadar MMP-9 yang mengalami gagal jantug akut lebih tinggi dibanding yang tidak. Dan bila kadar MMP-9 meningkat diatas 1444 ng/mL, kemungkinan terjadinya gagal jantung akut sebesar 4,2 kali.

Background: Acute heart failure (AHF) after acute coronary syndrome (ACS) is the biggest complication with a poor prognosis in a long term. The influence of MMP-9 as proteolytic enzyme that degrades extracellular matrix in remodeling left ventricle was recognized. However, according to researcher’s knowledge, evaluation of the MMP-9 as a predictor of AHF after ACS was never reported. Objective: To find out the serum level of MMP-9 in ACS with AHF higher than that without it, as well as to find out the level of MMP-9 with risk of AHF after ACS. Method: The study used a cross-sectional study. Samples were collected by using a consecutive sampling technique among patients with ACS treated in ICCU of Public Hospital Dr Sardjito Yogyakarta, since June 2008 to August 2010. Questionnaires were used to collect sample raw data. The level of MMP-9 was examined a time at admission in ICCU before trombolysis was done. The heart failure had Killip II- IV scores. Factors influencing the incidence was analyzed by using multivariate analysis technique. A significance level was at p< 0.05. The relative risk of acute heart failure at a certain level of MMP-9 (from cut-off value) was obtained after it was adjusted. Result: Among 122 subjects, 75 was without AHF and 47 with AHF. Median of the level of MMP-9 in the whole sample of ACS was 1248.55 ng/mL with a minimum of 170.50 ng/mL and maximum of 3058.40 ng/mL. Moreover, the level of MMP-9 in ACS with AHF (1700.81±740.43 ng/mL) was significantly higher than ACS without AHF (1189.55±654.60 ng/mL) with p value = 0.000. Independent risk factor after the multivariate analysis was done indicates the level of MMP-9 above 1444 ng/mL (RR= 4.2) and the location of anterior infarction (RR= 2.9). Conclusion: In patients with ACS treated in ICCU of RSUP Dr Sardjito, the level of MMP-9 with AHF was higher than that without it. If the level of MMP-9 above 1444 ng/mL, the possibility of AHF was 4.2 times.

Kata Kunci : SKA, MMP-9, gagal jantung akut paska SKA