Kompilasi Pada Intervensi Koroner Perkutan

Penyakit Jantung Koroner (PJK) merupakan salah satu penyebab kematian utama di seluruh dunia. Pada tahun 2012, data dari World Health Organization (WHO) menunjukkan penyakit jantung koroner merupakan penyebab kematian pertama dan bertanggung jawab akan 7,4 juta kematian di seluruh dunia. Penyakit jantung koroner menjadi kontributor terbesar dari penyakit kardiovaskular baik di negara maju maupun berkembang. PJK telah menjadi beban kesehatan maupun sosio-ekonomi karena mortalitasnya yang mencapai 7 juta kematian per tahun. Berdasarkan studi dari The Global Burden of Disease, sebanyak 7,8 juta dari 11,11 juta kematian akibat penyakit jantung koroner diprediksi akan terjadi di negara berkembang pada tahun 2020. Terapi revaskularisasi merupakan suatu pendekatan terapi penyakit jantung koroner yang penting di samping terapi medis yang optimal. Saat ini, terdapat dua pilihan terapi revaskularisasi pada penyakit jantung iskemik kronik, yaitu Percutaneus Coronary Intervention (PCI) dan Coronary Artery Bypass Graft (CABG)

Case Report: INTRAPROCEDURAL STENT THROMBOSIS IN PERCUTANEOUS CORONARY ANGIOPLASTY

Stent thrombosis is a rare complication of PCI but associated with STEMI and sudden cardiac death. Intra procedural stent thrombosis (IPST) was defined new or increasing (compared with baseline) thrombus within or adjacent to a deployed stent occurring the index PCI procedure whether occlusive or nonocclusive. We describe a case with double vessel disease who has complication cardiac arrest and intra procedural stent thrombosis in LAD and Left Main coronary artery after deployed stent in bifurcation LAD-D1. Thrombectomy and rescucitation were performed, and the patient completed her hospital course without complications

Tatalaksana Khusus Pada Intervensi Koroner Perkutan

Penyakit Jantung Koroner (PJK) merupakan salah satu penyebab kematian utama di seluruh dunia. Pada Tahun 2012 data dari World Health Organization (WHO) menunjukkan penyakit jantung koroner merupakan penyebab kematian pertama dan bertanggung jawab akan 7,4 juta kematian di seluruh dunia. Chronic Total Occlusion (CTO) arteri koroner merupakan tantangan besar dan dilema yang belum terpecahkan di bidang kardiologi intervensi. Pada komunitas ahli kardiologi, masih terdapat keraguan mengenai indikasi dilakukan PCI pada CTO serta masih terdapat rasa skeptis mengenai hasil dilakukannya revaskularisasi pada CTO. Prevalensi CTO dari semua pasien yang menjalani angiografi koroner bervariasi antara 18-52% bergantung dari profil klinis pasien yang diperiksa

PCI IN PATIENT WITH HEAVY CALCIFIED LESION. MANAGEMENT AND BALLOON RUPTURE COMPLICATION

Balloon angioplasty in calcified coronary lesions may have a decreased success rate and an increased incidence of complications. This lesion remain a technical challenge in interventional cardiology despite novel approaches and devices. We describe a case with heavy calcified coronary lesion in LAD that was not only resistant to high-pressure inflation of conventional, non-compliant balloons and cutting balloon but the inflations also results in balloon rupture. Even, the first balloon became fracture and entrapment in LAD. The fractured balloon could be removed using second baloon inflation in LCX. The angioplasty balloon was successfully performed after rotational atherectomy by rotablator and succesfully continued by implantation stent DES

Case Report: ENDOVASCULAR STENTING IN PERIPHERAL ARTERIAL DISEASE OF LOWER EXTREMITY

Peripheral arterial disease (PAD) is usually caused by multilevel atherosclerotic disease, typically in patients with a history of cigarette smoking, diabetes mellitus, or both. Intermittent claudication (IC), an early manifestation of PAD, commonly leads to reduced quality of life for patients who are limited in their ambulation. Percutaneous intervention for peripheral artery disease has evolved from balloon angioplasty for simple focal lesions to multimodality techniques that enable treatment of severe arterial insufficiency. Especially for high-grade stenoses or short arterial occlusions, percutaneous transluminal angioplasty (PTA) should be the method of first choice followed by the best surgical procedure later on. To achieve good long-term efficacy, a close follow-up including objective tests of both the arterial lesion and hemodynamic status, surveillance of secondary preventive measures and risk factor control is mandatory

Perkembangan Terapi Intervensi pada Penyakit Jantung Koroner

Penyakit kardiovaskular merupakan 30% penyebab dari seluruh angka kematian di dunia. Sebanyak lebih dari 17 juta populasi dunia per tahun dan diduga akan semakin meningkat menjadi 23,6 juta pada tahun 2030. Penyakit jantung koroner menjadi kontributor terbesar dari penyakit kardiovaskular baik di negara maju maupun berkembang. Studi The Global Burden of Disease menunjukkan bahwa penyakit jantung koroner diprediksi akan menjadi penyebab kematian pada 7,8 juta dari 11,11 juta penduduk di negara berkembang pada tahun 2020. Penyakit Jantung Koroner (PJK) merupakan penyakit jantung yang salah satunya disebabkan oleh adanya penyempitan arteri koronaria akibat proses arterosklerosis atau spasme atau kombinasi dari keduanya. Angka mortalitas PJK mencapai 7 juta kematian per tahun dan hal ini tidak hanya menjadi beban kesehatan namun juga menjadi beban sosio-ekonomi. Terapi revaskularisasi merupakan suatu pendekatan terapi penyakit jantung koroner yang penting selain terapi medis yang optimal. Pilihan terapi revaskularisasi pada penyakit jantung iskemik kronik saat ini yaitu Percutaneus Coronary Intervention (PCI) dan Coronary Artery Bypass Graft (CABG)

Hyperkalemia Associated with Angiotensin Converting Enzyme Inhibitor or Angiotensin Receptor Blockers in Chronic Kidney Disease

Inhibition of the renin-angiotensin-aldosterone system (RAAS) is a key strategy in treating hypertension in cardiovascular and renal diseases. However, RAAS inhibitors (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors) increase the risk of hyperkalemia (serum potassium >5.5 mmol/L). This poses a therapeutic challenge because these patient groups comprise in whom the drugs are therapeutically indicated. Important considerations when initiating ACEI or ARB therapy include obtaining an estimate of glomerular filtration rate and a baseline serum potassium concentration, as well as assessing whether the patient has excessive potassium intake from diet, supplements, or drugs that can also increase serum potassium. Serum potassium monitoring shortly after initiation of therapy can assist in preventing hyperkalemia. If hyperkalemia does develop, prompt recognition of cardiac dysrhythmias and effective treatment to antagonize the cardiac effects of potassium, redistribute potassium into cells, and remove excess potassium from the body is important. Understanding the mechanism of action and monitoring of ACEI and ARB coupled with judicious drug use and clinical vigilance can minimize the risk to the patient of developing hyperkalemia

Case Report: Thrombocytopenia in a Patient Undergoing Primary Percutaneous Coronary Intervention

Thrombocytopenia is a common abnormality in patients presenting with acute coronary syndrome. Baseline thrombocytopenia in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with early adverse events, related to both ischemia and bleeding. Treatment for acute coronary syndrome usually involves antiplatelet, anticoagulant, antithrombotic therapy, and the performance of percutaneous coronary intervention. The safety of antiplatelet therapy and percutaneous coronary intervention patients who have acute coronary syndrome and thrombocytopenia is unknown, and there are no guidelines or randomized studies that specifically suggest a treatment approach in such patients. One of the institutions in Italy recommends medical and interventional strategy with radialis as first choice for access site, bare metal stent (BMS) implantation, followed by double antiplatelet therapy (DAPT) for one month. After DAPT discontinuation, at least one antiplatelet drug (aspirin) is recommended for life

EFFECT OF STATINS ON ENDOTHELIAL PROGENITOR CELL (EPC) MIGRATION FROM PERIPHERAL BLOOD OF STABLE CORONARY ARTERY DISEASE PATIENT

Penelitian Klinis ABSTRAK   Efek Pemberian Statin Terhadap Migrasi Endothelial Progenitor Cell (EPC) Pada Darah Tepi Penderita Penyakit Jantung Koroner Stabil Tyagita Verdena Rani Savitri, Yudi Her Oktaviono, Djoko Soemantri   Latar Belakang: Endothlelial progenitor cell (EPC) berpartisipasi dalam perbaikan endotel dan pertumbuhan pembuluh darah baru. Farmakoterapi kardiovaskular telah dibuktikan dapat memperbaiki jumlah dan fungsi EPC pada penderita dengan risiko kardiovaskular. Banyak studi melaporkan bahwa statin memiliki efek yang menguntungkan terhadap EPC dengan meningkatkan jumlah dan fungsi EPC, termasuk didalamnya adalah fungsi migrasi. Oleh karena itu, kami melakukan penelitian untuk menganalisis efek tiga statin yang berbeda terhadap migasi EPC. Tujuan: Untuk menganalisis efek pemberian statin terhadap migrasi EPC pada darah tepi penderita penyakit jantung koroner stabil. Metode: Penelitian ini kami lakukan secara in vitro true experimental post-test only control group design. Sel mononuklear diisolasi dari darah tepi penderita penyakit jantung koroner stabil dan dilakukan kultur dalam medium Stemline II Hematopoietic Stemcell Expansion Medium selama 3 hari. Kemudian sampel dibagi menjadi empat kelompok yaitu kelompok simvastatin 0.5 µmol/L,, atorvastatin 0.5 µmol/L, rosuvastatin 0.5 µmol/L dan kelompok kontrol kemudian diinkubasi selama 48 jam. Metode imunositokimia dilakukan untuk identifikasi EPC dengan mengevaluasi ekspresi CD34+. Pada hari ke-5 kultur, sel di pindahkan ke bagian atas transwell system sebanyak 5x105 sel per sumur perlakuan , kemudian di inkubasi selama 1 hari. Sel yang berpindah pada sumur transwell system bagian bawah dihitung dengan automatic cell counter dengan pewarnaan typhan blue. Data dianalisis dengan independent t test dan ANOVA. Hasil: Hasil independent t test terhadap hasil migrasi pada transwell system menunjukkan peningkatan bermakna terhadap migrasi EPC pada kelompok simvastatin, atorvastatin, dan rosuvastatin dibandingkan dengn kelompok kontrol (234000 ± 1290. 994, 265000 ± 1290. 994, 203000 ± 1290. 994 vs 174071.43 ± 1426. 785, p<0.05). Migrasi EPC juga berbeda antar kelompok statin, dimana efek tertinggi didapatkan pada kelompok atorvastatin. Migrasi EPC pada kelompok atorvastatin lebih tinggi daripada kelompok simvastatin (265000 ± 1290. 994 vs 234000 ± 1290. 994, p<0.05), dan simvastatin lebih tinggi daripada kelompok rosuvastatin (234000 ± 1290. 994 vs 203000 ± 1290. 994, p<0.05). Pemeriksaan imunositokimia menunjukkan ekspresi positif terhadap CD34+. Kesimpulan: Statin meningkatkan migrasi EPC pada darah tepi penderita penyakit jantung koroner stabil. Efek tertinggi tampak pada kelompok atorvastatin, diikuti kelompok simvastatin, dan rosuvastatin.   Kata kunci: Migrasi EPC, simvastatin, atorvastatin, rosuvastatin     Clinical Research   ABSTRACT   Effect of Statins on Endothelial Progenitor Cell (EPC) Migration from Peripheral Blood of Stable Coronary Artery Disease Patient   Tyagita Verdena Rani Savitri Yudi Her Oktaviono Djoko Soemantri     Background: Endothelial progenitor cell (EPC) participates in endothelial repair and new blood vessel growth. Cardiovascular pharmacotherapy has been shown to improve the amount and function of EPC in patients with cardiovascular risk. Many studies report that statins have a beneficial effect on EPC by increasing the number and function of EPC, including the migration function. Therefore, we conducted a study to analyze the effects of three different statins on EPC migration. Objective: To analyze the effect of statins on EPC migration from peripheral blood of stable coronary artery disease (SCAD) patient. Methods: This was an in vitro true experimental post-test only control group design. The MNCs were isolated from peripheral blood of SCAD patient and were cultured in Stemline II Hematopoietic Stemcell Expansion Medium in 3 days. Then samples were put into four groups, simvastatin 0.5 µmol/L, atorvastatin 0.5 µmol/L, rosuvastatin 0.5 µmol/L and control, then incubated for 48 hours. Immunocytochemical examination was performed to evaluate expression of CD34+. On the 5th day of culture, 5x105 cells per group were transferred to the upper chamber of the transwell system, then incubated for 1 day. Cells that migrated to the lower chamber of transwell system were calculated by automatic cell counter with typhan blue coloring. Data were analyzed by independent T-test and ANOVA. Results: The results of independent T-tests showed a significant increase in EPC migration in the simvastatin, atorvastatin, and rosuvastatin groups compared with the control group (234000 ± 1290.994, 265000 ± 1290.994, 203000 ± 1290. 994 vs 174071.43 ± 1426 785, p <0.05). EPC migration also differed between statin groups, where the highest effect was found in the atorvastatin group. EPC migration in the atorvastatin group was higher than the simvastatin group (265,000 ± 1290,994 vs 234,000 ± 1290,994, p <0.05), and simvastatin was higher than the rosuvastatin (234,000 ± 1290,994 vs 203000 ± 1290. 994, p < 0.05). Immunocytochemical examination showed a positive expression on CD34+. Conclusion: Statins increase EPC migration from peripheral blood of SCAD patient. Atorvastatin showed the highest EPC migration, followed by simvastatin, and rosuvastatin. Keywords: EPC migration, simvastatin, atorvastatin, rosuvastatin   &nbsp

Effect of Sweet Purple Potato (Ipomoea batatas L.) Extract and Vitamin C on Endothelial Progenitor Cell Migration in Stable Coronary Disease Patient

Background: Number and function of Endothelial Progenitor Cells (EPC) are reduced incoronary artery disease (CAD) patient. EPC as progenitor of mature endothelial cell has important role for angiogenesis and neovasculogenesis. Dysfunctional EPC partly because of  oxidative stress. Decreasing oxidative stress with antioxidant especially with sweet purple potato extract and vitamin as easily found in Indonesia, may improve EPC migration to ischemic organ in stable CAD patient. Purpose : To analyze effect of sweet purple potato (Ipomoea batatas L.) extract and vitamin C on Endhotelial Progenitor Cell in Stable Coronary Disease patient. Method: This is experimental post-test control group study. Mononuclear cells (MNC) are isolated from peripheral blood of sample, and cultivated in medium for 3 days, immunofluorescence assay with CD34 as a marker for EPC. EPCs divided into sweet purple potato extract group (1 and 25 mcg/mL), vitamin C group (10 and 250 mcg/mL) and control, incubated for 2 days. 5x105 cell taken from each group and place in upper chamber of Transwell system. EPC migration was assessed in lower chamber of Transwell system after 24 hours using automated cell counters. Statistic testing using ANOVA. Results: EPC migration was increased significantly in sweet purple potato extract and vitamin C compared with control (3.03 ± 0.01, 2.15 ± 0.03 vs control 1.21 ± 0.04, p<0.01). Increased dose of sweet purple potato extract and vitamin C shows significantly increased of EPC migration (1.81 ± 0.02 vs1.47 ± 0.04 and 3.03 ± 0.01 vs 2.15 ± 0.03, p<0.01). There is significantly diferentiation between sweet potato purple extract and vitamin C (3.03 ± 0.01 vs 2.15 ± 0.03, p<0.01). Conclusion: Sweet purple potato extract and vitamin C increased EPC migration dose-dependently. Sweet purple potatao extract induces EPC migration better than vitamin C.                                                                                 Keywords: EPC migration, Stable CAD, sweet purple potato extract, vitamin C, antioxidant       &nbsp