Kadar High Sensitivity C Reactive Protein Plasma Sebagai Prediktor Kejadian Buruk Kardiovaskular pada Pasien Infark Miokard Akut dengan ST-elevasi

THOMAS RIKL, dr. Anggoro Budi Hartopo, M.Sc, Sp.PD, Ph.D; dr. Royhan Rozqie, Ph.D

2015 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang: Infark miokard akut dengan ST-elevasi (STEMI) menjadi masalah kesehatan jantung yang serius. Kejadian buruk kardiovaskular selama perawatan pasien STEMI masih dapat terjadi meskipun penanganan standar sudah dilakukan. Berbagai penelitian menunjukkan peningkatan kadar high sensitivity C Reactive Protein (hsCRP) di dalam plasma terbukti meningkatkan resiko kejadian buruk kardiovaskular pada pasien STEMI. Namun, penggunaan kadar hsCRP sebagai prediktor kejadian buruk kardiovaskular pada pasien STEMI masih perlu diteliti. Tujuan: Menyelidiki peningkatan kadar hsCRP plasma sebagai prediktor dalam terjadinya kejadian buruk kardiovaskular selama perawatan intensif pada pasien infark miokard akut dengan ST-elevasi. Metode: Sebanyak 163 pasien STEMI diikutsertakan dalam penelitian ini. Kadar hsCRP diperiksa dengan metode imunoturbidimetrik. Kejadian buruk kardiovaskular diamati selama perawatan intensif di ICCU RSUP Sardjito. Nilai titik potong kadar hsCRP ditentukan menggunakan kurva ROC (receiver operator curve). Pasien dikelompokkan dan proporsinya dianalisis dengan uji x2. Hasil: Uji x2 menunjukkan korelasi yang signifikan antara peningkatan kadar hsCRP dengan peningkatan resiko kejadian buruk kardiovaskular (p=0,017). Nilai titik potong kadar hsCRP plasma untuk memprediksi kejadian buruk kardiovaskular adalah 0,295 mg/L (sensitivitas 71,1% dan spesifisitas 52,8%). Pasien STEMI dengan kadar hsCRP plasma >0,295 mg/L memiliki resiko 2,20 lebih besar untuk mengalami kejadian buruk kardiovaskular selama perawatan intensif. Kesimpulan: Peningkatan kadar hsCRP pada pasien STEMI meningkatkan resiko terjadinya kejadian buruk kardiovaskular selama perawatan intensif.

Background: ST elevation myocardial infartion (STEMI) is a serious cardiac problem. Major adverse cardiac event (MACE) can still occur although standard management for STEMI has been given. Many studies show the increase of high sensitivity C Reactive Protein (hsCRP) in plasma has been proved to increase the risk of MACE in STEMI patient. Further research is needed before using plasma hsCRP level as predictor of MACE. Objective: To investigate the increase of hsCRP in plasma as a predictor of MACE in patients with STEMI during intensive care. Method: 163 patients were included in this study. HsCRP level was measured by immunoturbidimetric method. MACE was observed during intensive care in ICCU RSUP Sardjito. Cut off point of hsCRP level that predicts the risk of MACE was obtained by ROC (receiver operator curve). The patients was divided into two groups. The proportion of those groups was analyzed using x2 test. Result: The x2 test result shows that there is significant correlation between the increase of hsCRP level in plasma and the increase of MACE risk (p=0.017). The cut off point of hsCRP level in plasma that predicts MACE is 0,295 mg/L (71.1% sensitivity and 52.8% specificity). STEMI patients which have hsCRP level in plasma >0.295 mg/L tend to have 2.20 times risk of having MACE during the intensive care. Conclusion: The increase of hsCRP level in STEMI patients increases MACE risk during the intensive care.

Kata Kunci : high sensitivity C Reactive Protein (hsCRP), kejadian buruk kardiovaskular, infark miokard akut dengan ST-elevasi (STEMI)