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Effect of homocysteine and mean platelet volume on jenkins modified gensini score in acute myocardial infarction



Abstract

Pendahuluan:
Penyakit jantung koroner merupakan penyebab utama kematian di negara berkembang. The world health organization (WHO) memperkirakan pada tahun 2020 angka kejadian penyakit jantung koroner akan meningkat dari 7,1 juta ke 11,1 juta. Aterosklerosis adalah salah satu penyebab penyakit jantung koroner. Pada beberapa penelitian melaporkan faktor risiko terjadinya aterosklerosis diantaranya seperti merokok, hipertensi, diabetes dan kadar homosistein. Selain faktor risiko seperti aterosklerosis, trombosit mempunyai peran penting dalam terjadinya penyakit jantung koroner seperti sindroma koroner akut. Peningkatan aktivitas trombosit yang diukur dengan mean platelet volume (MPV) juga meningkatkan angka kejadian sindrom koroner akut. Penelitian ini bertujuan untuk mengetahui hubungan kadar homosistein dan mean platelet volume terhadap derajat keparahan stenosis koroner pada pasien sindroma koroner akut.
Bahan dan Metode:
Desain penelitian ini adalah observasional dengan pendekatan potong lintang dan dilakukan pada bulan Juni - Agustus 2018. Jumlah sampel pada penelitian ini adalah 47 pasien. Semua subjek penelitian yang memenuhi kriteria inklusi dilakukan anamnesis dan pemeriksaan fisik meliputi usia, jenis kelamin, berat badan, tinggi badan, tekanan darah, riwayat dislipidemia, riwayat diabetes, riwayat hipertensi, dan pemeriksaan laboratorium rutin. Setelah itu dilakukan pengambilan sampel darah untuk pemeriksaan kadar homosistein dan MPV, pemeriksaan angiografi koroner dan dilakukan penilaian derajat keparahan stenosis koroner melalui skor gensini modifikasi Jenkins. Kemudian dilakukan analisis korelasi plasma homosistein dan mean platelet volume dengan skor gensini modifikasi Jenkins.
Hasil:
Dari total 47 subjek penelitian, didapatkan 30 pasien (64%) laki-laki dengan usia rata-rata pada subjek penelitian hampir 60 ± 10 tahun. Nilai profil lipid, parameter jantung pada umumnya dalam batas normal. Terdapat peningkatan leukosit di atas nilai maksimum dengan nilai rata-rata 11.600 /mL. Nilai rata-rata homosistein serum keseluruhan pasien berada pada 12 mmol/L dengan tingkat deviasi sekitar 3,1 mmol/L, sedangkan nilai MPV berada pada 9,8 ± 0,7 fL. Pada penelitian ini menunjukkan peningkatan kadar homosistein 1 mmol/L menyebabkan kemungkinan individu mengalami stenosis arteri koroner dengan skor modifikasi gensini > 13 sebesar dua kali lipat. Hubungan MPV dengan keparahan stenosis arteri koroner memperlihatkan pasien dengan MPV 9,6-10,5 fL mengalami reduksi odd lesi berat sebesar 1,000 - 0,021 dibandingkan £ 9,5 fL. Terdapat hubungan yang positif antara kadar homosistein dengan keparahan stenosis arteri koroner, akan tetapi hubungan MPV dan keparahan stenosis arteri koroner belum terjawab penuh dengan data yang ada.


Introduction:
Coronary heart disease is a leading cause of death in developing countries. The world health organization (WHO) estimates that by 2020 the incidence of coronary heart disease will increase from 7.1 million to 11.1 million. Atherosclerosis is the main cause of coronary heart disease. Several studies reported risk factors for atherosclerosis include smoking, hypertension, diabetes and homocysteine levels. In addition to risk factors such as atherosclerosis, platelets have an important role in developing coronary heart disease in the form of acute coronary syndromes. Increased platelet activity as measured by mean platelet volume (MPV) also increases the incidence of acute coronary syndrome.This study aims to determine the relationship between homocysteine levels and mean platelet volume to the severity of coronary stenosis in patients with acute coronary syndrome.
Method:
This is an observational study with a cross-sectional approach and was carried out in June—August 2018.

The number of samples in this study were 47 patients. All study subjects who met the inclusion criteria were taken history and physical examination including age, sex, weight, height, blood pressure, history of dyslipidemia, history of diabetes, history of hypertension, and routine laboratory examinations. After that, the subject who met the inclusion criteria had blood samples examination for homocysteine levels and MPV, and then underwent coronary angiography examination and performed an assessment of the severity of coronary stenosis through Jenkins modified gensini score. Finally, statistical analysis was performed to find correlation between plasma homocysteine and mean platelet volume with Jenkins modified gensini score.

Result:
From a total of 47 subjects, 30 patients (64%) were male with an average age of nearly 60 ± 10 years. The value of the lipid profile, cardiac parameters are generally within normal limits. There is an increase in leukocytes above the upper limit value with an average value of 11,600 /mL. The average value of whole serum homocysteine in the patient is at 12 mmol/L with a deviation levels of about 3.1 mmol/L, while the MPV value is at 9.8 ± 0.7 fL. In this study, we found that an increase in homocysteine levels of 1 mmol/L causing the possibility of individuals experiencing coronary artery stenosis with a gensini score of > 13 by 2-fold. The association between MPV and the severity of coronary artery stenosis showed patients with MPV 9.6-10.5 fL experienced a reduction in severe lesion odds of 1.000-0.021 compared to £ 9.5fL.

There is a positive relationship between homocysteine levels and the severity of coronary artery stenosis, but the relationship between MPV and severity of coronary artery stenosis has not been fully answered with available data.

Keywords: Infark Miokard Akut homocysteine mean platelet volume modified Gensini score

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How to Cite

Susanto, D. H., Lefrandt, R. L., Panda, A. L., Pangemanan, J. A., Wijaya, H., Rooroh, V., Haurissa, A. E., & Sarayar, A. M. (2019). Effect of homocysteine and mean platelet volume on jenkins modified gensini score in acute myocardial infarction. Medicina, 50(2). https://doi.org/10.15562/medicina.v50i2.670
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Deddy Hermawan Susanto
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Reginald Leopold Lefrandt
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Agnes Lucia Panda
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Janry Antonius Pangemanan
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Hariyanto Wijaya
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Victor Rooroh
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Andreas Erick Haurissa
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Agustinus Mahardhika Sarayar
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