LIPOPROTEIN (a) SEBAGAI PREDIKTOR LUARAN BURUK (MAJOR ADVERSE

CARDIAC EVENTS) SELAMA PERAWATAN INTENSIF ACUTE MYOCARDIAL

INFARCTION

FEMINA SUSANTI, dr.Setyawati, Sp.PK-K

2015 | Tesis | S2 KEDOKTERAN KLINIK/MS-PPDS

 Abstrak
 File Pdf

Acute Myocardial Infarction (AMI) merupakan penyebab kematian utama di dunia dan
merupakan penyebab kematian pertama di Indonesia pada tahun 2002 dengan angka mortalitas
220.000 (14%) (WHO, 2008).Major adverse cardiac events (MACE) atau major cardiac events
(MCE) sebagai kejadian kardiovaskuler utama selanjutnya yang merugikan, merupakantitik
akhiryang umum digunakandalam penelitiankardiovaskular. Komplikasi AMI sebagian besar
muncul 72 jam pertama dari onset infark, dan dapat berlangsung 4 sampai 6 minggu. Insidensi
MCE selama fase akut AMI terdiri berbagai macam, beberapa dikategorikan sebagai kematian
kardiak, reinfark dan gangguan hemodinamik (gagal jantung akut dan syok kardiogenik).
Liporotein (a) [Lp(a)] salah satu penyebab penyakit kardioserebrovaskuler yang berkaitan
dengan aterotrombosis, berhubungan dengan perkembangan lesi koroner baru sesudah serangan
AMI. Kadar Lp(a) ≥ 30 mg/dL dihubungkan dengan peningkatan kejadian MCE.Penelitian
ini bertujuan untuk menilai kadar Lp(a) ≥ 30 mg/dLdalam memberikan risiko luaran buruk
(MCE)selama perawatan intensif pasien AMI. Analisis penelitian menggunakan analisis regresi
logistik dan multipel regresi. Hasil penelitian menunjukkan rerata Lp(a) pada MCE (+) 37,72 ±
22,75 dan MCE (-) 19,78 ± 13,5 (p=0,002). Analisis univariat terhadap faktor-faktor
prognostik luaran AMI (MCE) yang bermakna secara statitik (p<0,05) adalah Lp(a) (RR=5,11),
GDS (RR=5,00), Hipertensi (RR=4,2), dan jenis kelamin (RR=0,21). Analisis multivariat
terhadap faktor-faktor prognostik luaran AMI (MCE) yang bermakna secara statistik (p<0,05)
adalah Lp(a) (RR=9,53, 95%CI=2,18-41,58) dan hipertensi (RR=7,58, 95%CI=1,34-42,85).
Kadar Lp(a) ≥ 30 mg/dL memberikan risiko 9,53 kali luaran buruk (MCE) selama perawatan
intensif pasien AMI. Perlu dilakukan pemeriksaan Lp(a) pada penderita AMI sebagai prediktor
independen luaran buruk (MCE). Perlu penelitian lebih lanjut tentang Lp(a) sebagai prediktor
luaran buruk AMI (MCE) dengan meningkatkan pengendalian terhadap faktor prognostik lain.

Acute Myocardial Infarction (AMI) is the leading cause of death in the world and the first cause
of death in Indonesia in 2002 with the mortality rate 220,000 (14%) (WHO, 2008).Major
adverse cardiac events (MACE) or major cardiac events (MCE), the next major cardiovascular
events that harm, are the endpoint common used in cardiovascular research. Complications of
AMI mostly appear at the first 72 hours of the onset of infarction, and can last for 4 to 6 weeks.
There are various kinds of incidence of MCE during the acute phase of AMI, some of them are
categorized as cardiac death, reinfarction and hemodynamic disorders (acute heart failure and
cardiogenic shock). Liporotein (a) [Lp(a)],one of the causes of cardiocerebrovaskuler disease
that related to atherothrombotic, associated with the development of new coronary lesions after
AMI attack.The levels of Lp(a) ≥ 30 mg/dL is associated with the increasing of
MCEincidence. This study is aimed to assess the levels of Lp(a) ≥ 30 mg/dLin giving the bad
risk output (MCE) during intensive care of AMI patients. Research analysisuses linear
regression analysis and multiple regression. The results showed mean of Lp (a) in the MCE (+)
were 37.72 ± 22.75 and MCE (-) were 19.78 ± 13.5 (p = 0.002). Univariate analysis of the
MCEprognostic factors that statistically significant (p <0.05) were Lp (a) (RR = 5.11), GDS (RR
= 5.00), hypertension (RR = 4, 2), and gender (RR = 0.21). Multivariate analysis of
MCEprognostic factorsthat statisticallysignificant(p <0.05)were Lp (a) (RR = 9.53, 95% CI =
2.18 to 41.58) and hypertension (RR = 7.58, 95% CI = 1.34 to 42.85). Levels of Lp (a) ≥ 30
mg/dLshowed risk 9.53 times of bad outcomes (MCE) of AMI patients during intensive care. Lp
(a) in patients with AMI need to check as an independent predictor of poor outcome (MCE).
Further research on Lp (a) as a predictor of poor outcome AMI (MCE) was needed with
improvementin controlling other prognostic factors.