Rasio Monosit-High Density Lipoprotein (RMH) sebagai prediktor independen kejadian kardiovaskular mayor selama rawat inap pada pasien Infark Miokard Akut (IMA) yang menjalani intervensi koroner perkutan di RSUP Sanglah, Bali, Indonesia

Ni Made Dharma Laksmi; I Gusti Ngurah Putra Gunadhi; Hendy Wirawan; Rani Paramitha Iswari Maliawan

doi:10.15562/ism.v11i3.800

Rasio Monosit-High Density Lipoprotein (RMH) sebagai prediktor independen kejadian kardiovaskular mayor selama rawat inap pada pasien Infark Miokard Akut (IMA) yang menjalani intervensi koroner perkutan di RSUP Sanglah, Bali, Indonesia

Ni Made Dharma Laksmi ,

I Gusti Ngurah Putra Gunadhi ,

Hendy Wirawan ,

Rani Paramitha Iswari Maliawan ,

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DOI: https://doi.org/10.15562/ism.v11i3.800 |
Published: 2020-12-01

Abstract

Background: Several inflammatory cell markers have been addressed in recent studies and one of them is the Ratio of Monocyte-High Density Lipoprotein (RMH) as a new predictor and prognostic indicator of cardiovascular disease. There is, however, still little evidence to relate RMH parameters to the severity of coronary lesions in patients with Acute Myocardial Infarction (AMI). In order to determine whether RMH was a predictor of Major Cardiovascular Events (MACE) in AMI patients who underwent percutaneous coronary intervention at the Sanglah General Hospital during hospitalization, this analysis was carried out.

Methods: This study was an observational study design with a cohort study approach. The selection of study subjects was carried out by consecutive sampling, with a total of 60 patients. AMI patients who underwent percutaneous coronary intervention were included in the affordable population and met the inclusion and exclusion criteria during the study period. Data were analyzed with SPSS version 23 for Windows.

Results: An independent measure of the occurrence of MACE during hospitalization in AMI patients is a high RMH value (RR = 1.459; p = 0.046; 95 percent CI = 1.028–25.366). In addition, it was found that independent predictors of mortality were smoking (RR = 1.555; p = 0.039; 95% CI = 1.131-116.058), diabetes mellitus type 2 (DM-2) (RR = 1.507; p = 0.036; 95% CI = 1.133-45,368) and high TIMI (RR = 1.512; p = 0.026; 95% CI = 1.268-43.772).

Conclusion: In acute myocardial infarction patients, the high RMH value is an independent indicator of major cardiovascular events during hospitalization. Other variables such as diabetes mellitus, smoking, and the TIMI score were also found as predictors of major cardiovascular events during treatment in patients with acute myocardial infarction.

Latar Belakang: Berbagai studi terakhir, banyak membahas tentang penanda dari sel inflamasi, dan salah satunya Rasio Monosit-High Density Lipoprotein (RMH) sebagai prediktor baru dan indikator prognosis dari penyakit kardiovaskular. Namun masih sedikit data yang menghubungkan parameter RMH terhadap derajat keparahan lesi koroner pada pasien Infark Miokard Akut (IMA). Studi ini dilakukan untuk mengetahui apakah RMH merupakan prediktor terhadap Kejadian Karviovaskular Major (KKM) pada pasien IMA yang menjalani intervensi koroner perkutan selama rawat inap di Rumah Sakit Umum Pusat Sanglah.

Metode: Penelitian ini merupakan rancang studi observasional dengan pendekatan studi kohort. Pemilihan subjek penelitian dilakukan secara consecutive sampling dengan total 60 pasien. Pasien IMA yang menjalani intervensi koroner perkutan yang masuk populasi terjangkau dan memenuhi kriteria inklusi maupun eksklusi selama periode penelitian. Data dianalisis dengan SPSS versi 23 untuk Windows.

Hasil: Nilai RMH yang tinggi (RR=1,459; p=0,046; 95% IK=1,028–25,366) merupakan prediktor independen terhadap kejadian KKM selama rawat inap pada pasien IMA. Selain itu didapatkan bahwa merokok (RR=1,555; p=0,039; 95% IK=1,131-116,058), Diabetes Mellitus Tipe 2 (DM-2) (RR=1,507; p=0,036; 95% IK=1,133-45,368), dan TIMI yang tinggi (RR=1,512; p=0,026; 95% IK=1,268-43,772) merupakan prediktor independen terhadap mortalitas.

Kesimpulan: Nilai RMH yang tinggi merupakan prediktor indedepnden terhadap kejadian kardiovaskular mayor selama rawat inap pada pasien infark miokard akut. Didapatkan juga faktor lain seperti diabetes mellitus, merokok, dan skor TIMI sebagai prediktor terhadap kejadian kardiovaskular mayor saat perawatan pada pasien infark miokard akut.

References

Cetin MS, Ozcan Cetin EH, Kalender E, Aydin S, Topaloglu S, Kisacik HL, et al. Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome. Heart Lung Circ. 2016;25(11):1077-1086.
Handoyo V, Pertiwi GAR, Prabawa IPY, Manuaba IBAP, Bhargah A, Budiana IPG. Management of ST-elevation myocardial infarction in the setting of anterior epistaxis: focused on antiplatelet and antithrombotic therapies. Int Med Case Rep J. 2019;12:33-38.
Burke AP, Virmani R. Pathophysiology of acute myocardial infarction. Med Clin North Am. 2007;91(4):553-ix.
Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med. 2013;368(21):2004-2013.
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569-2619.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation. Rev Esp Cardiol (Engl Ed). 2015;68(12):1125.
Correia LC, Garcia G, Kalil F, Ferreira F, Carvalhal M, Oliveira R, et al. Prognostic value of TIMI score versus GRACE score in ST-segment elevation myocardial infarction. Arq Bras Cardiol. 2014;103(2):98-106.
Afiune Neto A, Mansur Ade P, Avakian SD, Gomes EP, Ramires JA. Monocytosis is an independent risk marker for coronary artery disease. Arq Bras Cardiol. 2006;86(3):240-244.
Nozawa N, Hibi K, Endo M, Sugano T, Ebina T, et al. Association between circulating monocytes and coronary plaque progression in patients with acute myocardial infarction. Circ J. 2010;74(7):1384-1391.
Jialal I, Devaraj S. Inflammation and atherosclerosis: the value of the high-sensitivity C-reactive protein assay as a risk marker. Am J Clin Pathol. 2001;116 Suppl:S108-S115.
Barron HV, Cannon CP, Murphy SA, Braunwald E, Gibson CM. Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: a thrombolysis in myocardial infarction 10 substudy. Circulation. 2000;102(19):2329-2334.
Kirtane AJ, Bui A, Murphy SA, Barron HV, Gibson CM. Association of peripheral neutrophilia with adverse angiographic outcomes in ST-elevation myocardial infarction. Am J Cardiol. 2004;93(5):532-536.
Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis in Myocardial Infarction 18 trial)substudy. J Am Coll Cardiol. 2002;40(10):1761-1768.
Bath PM, Gladwin AM, Martin JF. Human monocyte characteristics are altered in hypercholesterolaemia. Atherosclerosis. 1991;90(2-3):175-181.
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-2264.
Omstedt Å, Höijer J, Djärv T, Svensson P. Hypertension predicts major adverse cardiac events after discharge from the emergency department with unspecified chest pain. Eur Heart J Acute Cardiovasc Care. 2016;5(5):441-448.
Jurado-Román A, Hernández-Hernández F, García-Tejada J, Granda-Nistal C, Molina J, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol. 2015;115(9):1174-1178.
Ozcan Cetin EH, Cetin MS, Aras D, et al. Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction. Angiology. 2016;67(4):336-345.
Artha IMJR, Bhargah A, Dharmawan NK, Pande UW, Triyana KA, Mahariski PA, et al. High level of individual lipid profile and lipid ratio as a predictive marker of poor glycemic control in type-2 diabetes mellitus. Vasc Health Risk Manag. 2019;15:149-157.
Kurtul A, Acikgoz SK. Usefulness of Mean Platelet Volume-to-Lymphocyte Ratio for Predicting Angiographic No-Reflow and Short-Term Prognosis After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(4):534-541.
Ghattas A, Griffiths HR, Devitt A, Lip GY, Shantsila E. Monocytes in coronary artery disease and atherosclerosis: where are we now?. J Am Coll Cardiol. 2013;62(17):1541-1551.
Wang N, Lan D, Chen W, Matsuura F, Tall AR. ATP-binding cassette transporters G1 and G4 mediate cellular cholesterol efflux to high-density lipoproteins. Proc Natl Acad Sci U S A. 2004;101(26):9774-9779.
Murphy AJ, Woollard KJ. High-density lipoprotein: a potent inhibitor of inflammation. Clin Exp Pharmacol Physiol. 2010;37(7):710-718.
Kiziltune E, Alsancak Y, Sezenoz B, Ozkan S, Sivri S, Alsancak AD, et al. Relationship between monocyte/highdensity lipoprotein cholesterol ratio and angiographic severity and extent of coronary artery disease. Kosuyolu Heart J 2017;20(1):30-35.
Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46(8):1619-1625.
Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983;51(3):606.
Negri E, La Vecchia C, Nobili A, D'Avanzo B, Bechi S. Cigarette smoking and acute myocardial infarction. A case-control study from the GISSI-2 trial. GISSI-EFRIM Investigators. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto--Epidemiologia dei Fattori di Rischio dell'infarto Miocardioco. Eur J Epidemiol. 1994;10(4):361-366.
Kiani F, Hesabi N, Arbabisarjou A. Assessment of Risk Factors in Patients With Myocardial Infarction. Glob J Health Sci. 2015;8(1):255-262.