OUTCOME JANGKA PENDEK PASIEN PENYAKIT JANTUNG KORONER MULTIVESSEL STABIL KANDIDAT UNTUK OPERASI CORONARY ARTERY BYPASS GRAFTING DENGAN GAMBARAN EKG NORMAL

  • Edwin Hartanto
  • Khalid Saleh
  • Abdul Hakim Alkatiri
  • Peter Kabo

Abstract

Pendahuluan: Berbagai studi sebelumnya yang melihat outcome pada pasien PJK multivessel stabil baik yang menjalani CABG, PCI, maupun yang hanya mendapat terapi obat tidak mempertimbangkan gambaran EKG yang mungkin berpengaruh pada outcome. Studi ini bertujuan untuk melihat outcome jangka pendek pasien PJK multivessel stabil kandidat untuk operasi CABG dengan gambaran EKG normal. Metode: Studi Kohort. Outcome primer yang dinilai berupa angina berulang, kejadian SKA, stroke dan kematian karena berbagai sebab dalam 6 bulan. Data dianalisis menggunakan SPPSS versi 16. Data dinyatakan signifikan jika nilai p<0.05. Hasil: Didapatkan 79 pasien (69 pria dan 10 wanita) dikelompokkan pada kelompok yang menjalani CABG(n=13), PCI (n=12), maupun terapi obat (n=54). Kejadian bebas SKA dalam 6 bulan pada kelompok CABG sebanyak 100%, kelompok PCI sebanyak 75%, dan kelompok terapi obat sebanyak 85.1%. Dalam ikutan selama 6 bulan, kejadian bebas angina pada kelompok CABG sebanyak 87.4%, kelompok PCI sebanyak 67% dan kelompk terapi obat sebanyak 42.9% (p=0.015 & OR=7.413). Kesimpulan: Terapi obat untuk PJK multivessel berhubungan dengan kejadian SKA yang lebih rendah dibandingkan PCI dalam 6 bulan. CABG lebih superior dibandingkan terapi obat dalam menghilangkan gejala angina. Ketiga strategi terapi berhubungan dengan tingkat kematian yang rendah dalam 6 bulan.

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DAFTAR PUSTAKA
1. Pusat data dan Informasi Kementrian kesehatan RI. 2014
2. Mahmoodzadeh S, Moazenzadeh M, Sheikhvatan M. Diagnostic performance of electrocardiography in the assessment of significant coronary artery disease and its anatomical size in comparison with coronary angiography. Journal of research in med sciences. 2011
3. Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with denovo leftmain disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2010;121(24): 2645–2653.
4. Beller GA, Ragosta M. Decision making in multivessel coronary disease: the need for physiological lesion assessment. JACC. 2010
5. Hueb W, Lopes N, Gersh BJ, et al. Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of3 therapeutic strategies for multivessel coronary artery disease. Circulation: 2010; 122(10):949–957.
6. De Bruyne B, Pijls NH, Kalesan B, et al. Fractional ?ow reserve-guided PCI vs. medical therapy in stable coronary disease. N Engl J Med:2012;367(11): 991–1001.
7. Hannan EL, Samadashvili Z, Cozzens K, et al. Comparative outcomes for patients who do and do not undergo percutaneous coronary intervention for stable coronary artery disease in New York. Circulation 2012;125(15): 1870–1879.
8. Jeremias A, Kaul S, Rosengart TK, et al. The impact of revascularization on mortality in patients with nonacute coronary artery disease. Am J Med 2009;122(2):152–161
9. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. NEJM. 2007;356(15):1503–1516
10. Kapoor JR, Gienger AL, Ardehali R, et al.Isolated disease of the proximal left anterior descending artery comparing the effectiveness of percutaneous coronary interventions and coronary artery bypass surgery. JACC Cardiovasc Interv: 2008;1(5):483–491
11. Lima EG, Hueb W, Garcia RM, et al. Impact of diabetes on 10 year outcomes of patient with multivessel coronary artery disease in the medicine, Angioplasty, or Surgery II(MASS II) trial. Am Heart J. 2013
12. Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med. 2003
13. Otaki Y, Gransar H, Berman DS, et al. Impact of family history of coronary artery disease in young individuals (from the CONFIRM registry). Am J Cardiol. 2013;111:1081-1086
14. Lavie CJ, Milani RV. Obesity and cardiovascular disease: the Hippocrates paradox?. J Am Coll Cardiol .2003;42:677–9.
15. Farkouh ME, Domanski M, Sleeper LA, et al.Strategies for multi vessel revascularization in patients with diabetes. N Engl J Med 2012;367(25):2375–2384
16. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention vs. coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med: 2009;360(10): 961–972.
17. Mozaffarian D, Benjamin EJ, Go As, et al. Heart disease and stroke statistics. Circulation. 2016
18. Tarakji KG, Sabik JF, Bhudia SK, et al. temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011
19. Park DW, Kim YH, Yun SC, et al. Long-term outcomes after stenting vs. coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry.J Am CollCardiol: 2010;56(17):1366–1375
20. Park SJ, Kim YH, Park DW, et al. Randomized trial of stents vs. bypass surgery for left main coronary artery disease. N Engl J Med 2011;364(18):1718–1727.
21. Park J, De backer G, Gohlke H, et al. European Guidelines on cardiovascular on cardiovascular disease prevention in clinical practice (Version 2012). Eur Heart J. 2012;33:1635-1701
22. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. NEJM. 2008;359: 2105–20.
23. Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368:666 –78.
24. Sierra-Johnson J, Romero-Corral A, Somers VK, et al. Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index. Eur Cardiovasc Prev Rehabil. 2008;15:336–40
25. Rosendorff C, Lackland DT, Allison M, et al. Treatment of hypertension in patients with coronary artery disease. JACC. 2015
Published
2019-09-11
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How to Cite
Hartanto, E., Saleh, K., Alkatiri, A., & Kabo, P. (2019). OUTCOME JANGKA PENDEK PASIEN PENYAKIT JANTUNG KORONER MULTIVESSEL STABIL KANDIDAT UNTUK OPERASI CORONARY ARTERY BYPASS GRAFTING DENGAN GAMBARAN EKG NORMAL. Indonesian Journal of Cardiology, 39(2). https://doi.org/10.30701/ijc.v39i2.634