x INTISARI Sindroma koroner akut (SKA) merupakan

INTISARI
Sindroma koroner akut (SKA) merupakan kumpulan gejala klinik penyakit
arteri koroner trombotik dengan kelainan dasar aterosklerosis yang menyebabkan
plak aterom. Diagnosis SKA dari gejala klinis, elektrokardiografi (EKG) dan petanda
jantung troponin. Berdasarkan patofisiologi SKA, inflamasi berperan pada semua
tahapan aterosklerosis, meliputi inisiasi, pertumbuhan, dan komplikasi. Inflamasi
berkontribusi dalam aterogenesis dan aterotrombosis akut.
C-reactive protein (CRP) merupakan reaktan fase akut sebagai petanda
inflamasi yang bersifat proaterogenik dan aterotrombosis. Inflamasi intralesi dan
ekstralesi dapat mempercepat evolusi ateroma dan memicu kejadian akut pada SKA
yang ditunjukkan melalui peningkatan kadar high sensitivity-CRP (hs-CRP). High
sensitivity-CRP merupakan CRP dengan metode pengukuran deteksi kadar yang lebih
rendah yaitu 0,1-15,0 mg/L. Respon sistem inflamasi yang berlebihan semakin
meningkatkan CRP, pada gilirannya dapat memediasi kerusakan miokard dan
komplikasi jantung. Glukosa merupakan salah satu mediator penting respon inflamasi
baik pada diabetes maupun non-diabetes. Stres hiperglikemia adalah petanda yang
lebih terkait langsung dengan tingkat kerusakan miokard akut, infark yang lebih besar
akan mengaktivasi saraf simpatis dan sekresi hormon counter regulatory lebih lanjut,
menyebabkan hiperglikemia lanjut yang memperburuk inflamasi, berpotensi
membentuk siklus “lingkaran yang tidak terputus”, mengakibatkan kerusakan
membran sel lebih lanjut yang akhirnya menyebabkan kematian. Kadar glukosa yang
tinggi menyebabkan up-regulation sintesis CRP di makrofag. Peningkatan hs-CRP
dan glukosa merupakan faktor prognostik major adverse cardiac event (MACE) pada
SKA.
Penelitian ini merupakan studi kohort prospektif, bertujuan mengetahui nilai
prognostik hs-CRP dan glukosa saat masuk perawatan rumah sakit pada pasien SKA
di ICCU RSUP Dr.Sardjito Yogyakarta dengan luaran MACE berupa: kematian,
reinfark, syok kardiogenik, gagal jantung akut, ventricular tachycardia and
fibrillation (VT/VF), urgent - percutaneous coronary intervention (PCI), dinilai
dalam 7 hari perawatan. Pemeriksaan hs-CRP dan glukosa masing-masing dengan
metode immunoturbidimetric dan hexokinase-G6PD. Nilai prognostik dalam bentuk
risiko relatif (RR).
Kata kunci : Sindroma Koroner Akut, CRP, hs-CRP, glukosa, hiperglikemia,
Unstable angina, NSTEMI, STEMI
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ABSTRACT
Acute coronary syndrome (ACS) is a collection of clinical symptoms of
coronary artery disease with thrombotic disorders that cause atherosclerosis basis
atherom plaque. ACS diagnosis obtained from the clinical symptoms,
electrocardiographic (ECG) and cardiac marker Troponin. Based on the
pathophysiology of ACS, inflammation plays a role in all stages of atherosclerosis,
including the initiation, growth, and complications of atherosclerotic plaque.
Inflammation contributes important in acute atherogenesis and further
atherothrombotic.
C-reactive protein (CRP) is an acute phase reactant that is a marker of
inflammation that is proaterogenic whose role in further atherothrombotic process.
Extralesion and intralesional inflammatory can accelerate the evolution of atheroma
and trigger acute events in ACS demonstrated through increased levels of highsensitivity CRP (hs-CRP). High-sensitivity CRP is a method of measuring CRP with
lower levels of detection is 0.1 to 15.0 mg / L. Excessive inflammatory response
system, the increase of CRP which in turn can mediate myocardial damage and
cardiac complications. Glucose is one of the important mediators of the inflammatory
response in both diabetic and non-diabetic. Stress hyperglycemia is a marker that is
more directly related to the rate of acute myocardial damage, larger infarcts activates
the sympathetic nervous and counter-regulatory hormone secretion further, causing
further hyperglycemia exacerbates inflammation, potentially forming a cycle
"unbroken circle", resulting in further damage to the cell membrane in ultimately lead
to death. At high glucose levels cause up-regulation of CRP synthesis in
macrophages. Increased hs-CRP and glucose is a prognostic factor of major adverse
cardiac events (MACE) in ACS.
This study is a prospective cohort study which aims to determine the
prognostic value of hs-CRP and glucose on admission in patients with ACS in the
ICCU Dr.Sardjito Yogyakarta Hospital with a MACE outcomes: death, reinfarction,
cardiogenic shock, acute heart failure, ventricular tachycardia and fibrillation
(VT/VF), urgent-percutaneous coronary intervention (PCI) were assessed during the
7 days of treatment. Examination of hs-CRP and glucose each with
immunoturbidimetric and hexokinase-G6PD method. The results of prognostic value
in the form of relative risk (RR).
Keywords : Acute Coronary Syndrome, CRP, hs-CRP, glucose, hyperglycemia,
Unstable angina, NSTEMI, STEMI
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