RISIKO KEMATIAN SELAMA PERAWATAN DI RUMAH SAKIT PENDERITA INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST (IMA‐EST) YANG DILAKUKAN TERAPI FIBRINOLITIK DIBANDING INTERVENSI KORONER PERKUTAN (IKP) PRIMER

Irsad Andi Arso, dr, Prof. Dr. Bambang Irawan SpPD., KKV., SpJP (K)

2012 | Tesis | S2 Kedokteran Klinik/EK

Latar belakang: Penelitian yang membandingkan terapi fibrinoltik dan intervensi koroner perkutan (IKP) primer pada penderita IMA-EST telah banyak dilaporkan di negara maju. Di negara berkembang terutama di rumah sakit daerah tindakan IKP primer baru dikerjakan pada 3 tahun terakhir sehingga penelitian belum banyak dilaporkan. Tujuan penelitian: Untuk mengetahui risiko kematian di rumah sakit pada penderita IMA-EST yang mendapatkan terapi fibrinolitik dibanding tindakan IKP primer selama perawatan di rumah sakit. Metodologi dan cara penelitian: Penelitian kohort retrospektif dengan melihat rekam medik penderita IMA-EST onset <12 jam yang dilakukan terapi fibrinolitik dan tindakan IKP primer di rumah sakit umum Dr. Sardjito Yogyakarta mulai 1 Januari 2008 sampai dengan 31 Maret 2010. Luaran klinik: Luaran klinik utama: kejadian kematian sebab kardiovaskular dan luaran klinik sekunder: gangguan hemodinamik, iskhemik pasca infark dan efek samping perdarahan selama perawatan di rumah sakit. Hasil penelitian: Dari 78 penderita yang mendapat terapi fibrinolitik dan 53 penderita yang dilakukan tindakan IKP primer, ditemukan kematian sebab kardiovaskular selama perawatan di rumah sakit tidak berbeda bermakna yaitu 6,4 % vs 7,5% (RR 0,83., 95% CI 0,21-3,28; p=0,80), gagal jantung lebih tinggi dan berbeda bermakna pada terapi fibrinolitik 17,9% vs 5,7% (RR 3,64; 95% CI 0,99- 13,38, p=0,04), penurunan risiko relatif 68,1%. Angina pektoris pasca infark tidak berbeda bermakna yaitu 7% vs 3,8% (RR 2,51; 95% CI 0,50-12,60; p=0,24). Efek samping perdarahan baik mayor ataupun minor tidak berbeda bermakna yaitu 1,3% vs 0% (RR 1,68; 95% CI 1,46-1,94; p=1,0) untuk perdarahan mayor dan 12,8% vs 3,8% (RR 3,75; 95% CI 0,78-19,72; p=0,12) untuk perdarahan minor. Simpulan: Tidak ditemukan perbedaan bermakna kejadian kardiovaskular mayor penderita IMA-EST yang diterapi fibrinolitik dengan IKP primer selama perawatan di rumah sakit, kejadian gagal jantung lebih tinggi pada terapi fibrinolitik, dimana IKP primer menurunkan risiko relatif 6,81%, kejadian angina pektoris pasca infark tidak berbeda bermakna antara kedua kelompok. Efek samping perdarahan tidak berbeda bermakna.

Background: A study comparing fibrinolityc therapy and primary percutaneouscoronary intervention (PCI) in patients with STEMI has been reported in developed countries. Only few studies reporting the outcome of pirmary PCI in developing countries where this intervention had just routinely performed in the last 3 years. Objective: To observed the cardiovascular mortality in patients with STEMI who received fibrinolytic therapy compared with primary PCI during hospitalization. Methodology and Methods: we performed retrospective cohort study using medical record of STEMI patients with the onset <12 hours who received fibrinolytic therapy and primary PCI at Dr. Sardjito Hospital at Yogyakarta starting January 1st, 2008 until March 31st, 2010. Clinical outcomes: Primar outcomes was cardiovascular mortality and secondary outcomes were heart failure, post-infarction angina pectoris, and side effects of bleeding. Results: In 78 patients who received fibrinolityc therapy and 53 patients with primary PCI we found that cardiovascular mortality was not significantly different (6.4% vs 7.5% ; RR 0.83; 95% CI 0.21-3.28; p=0.80). Hearrt failure is higher and significantly different in fibrinolytic therapy patient ( 17.9% vs 5.7%; RR 3.64; 95% CI 0.99-13.38; p=0.04), with relative risk reduction 68.1%. Post-infarction angina pectoris was not significantly different (7% vs 3,8% RR 2.51; 95% CI 0.50-12.60; p=0.24).Side effects of major bleeding were not significantly different with was 1.3% vs 0% (RR 1.68; 95% CI 1.46-1.94; p=1.0) and minor bleeding 12.8% vs 3.8% (RR 3.75; 95% CI 0.78-19.72; p=0.12), for fibrinolytic vs primary PCI respectively. Conclusion: there were no significant differences of cardiovascular mortality in STEMI patient receieving fibrinolytic therapy compared with primary PCI during hospitalization. Incidency of heart failure was higher in fibrinolytic therapypatient, primary PCI reduces relative risk of 6.81%. Post-infarction angina pectoris was not significantly different in both group. The side effects of bleeding did not differ significantly.

Kata Kunci : kematian sebab kardiovaskular, IMA-EST, terapi fibrinolitik, tindakan IKP primer