HUBUNGAN ANTARA LUAS INFARK MIOKARD AKUT ( BERDASARKAN SKOR SELVESTER ) DENGAN KETAHANAN HIDUP SELAMA 6 BULAN

Abstract

Background : Long-term, post-AMI survival is mostly a function of the left ventricular. The function of the left ventricular is a reflection of the extent of infarction. The value of determination of the extent of infarction using Selvester QRS scoring method in the present study in addition to identify the patient's risk of possible death it also introduces an inexpensive, reprodicible, non invasive and easy method at place that is easiest to acces such as a doctor's office. Materials and Methods : Cohort study design was conducted to find the correlation between Selvester score and survival during 6-month observation in new AMI patients. In all patients with newly diagnosed A1v1I underwent treatment in the ICCU of Dr. Kariadi Hospital in Semarang during the period from July 2000 to April 2003 and met the selection criteria. In the first step we performed recording about: age and sex, several predisposing factors such as smoking, diabetes melitus, hypertension and hypercholesterolemia; several complication sucf as malignant ventricularl extrasystole, heart failure and the extent of infark. In the second step we performed (6-months observation) evaluation of survival activities in life if the patient was still alive. Statistical analyses were performed using chi-square, Fisher's absolute test, one way Anova and analysis using Kaplan Meier method with degree of significance p<0,05. Results : During the study period we found 30 patients with AMI underwent treatment in the ICCU of Dr. Kariadi Hospital in Semarang that met the selection criteria. The charecteristics of the patient included 26 males and 4 females. Ages were ranging from 37 to 74 years ( mean + SD = 55 + 8.85 years ). Smoking habit was found in 16 patients, the amount of cigarettes consumed were ranging between 3 to 30 cigarettes (mean + SD = 10,56+6,62 cigarettes/day ). Diabetes melitus 3, hypertension 15, hypercholestrolemia 5 and heart failure 5 patients. During the 6-months observation, three out of 5 patients with heart failure were died. From the statistical test it was found that there was a significant influence of heart failure on survival ( p=0,02 ). The Selvester score in the present study could not have given prediction on death ( p=0,298 ). Conclutions : Quantitative assesment of the extent of infarction using Selvester scoring method could not be used convincingly for predicting death. However, the association between Selvester score and survival can be explained descriptively on the basis of left ventricular function. Latar Belakang Ketahanan hidup jangka panjang terpenting paska IMA adalah fungsi ventrikel kiri. Adapun fungsi ventrikel kiri merupakan refleksi luasnya infark. Manfaat pengukuran luas infark dengan metode skor QRS skor Selveter dalam penelitian ini selain dapat mengidentifikasi risiko penderna terhadap kernungkinan kernatian juga diperkenalkan suatu metode yang murah, dapat diulang, non invasiv dan mudah dikerjakan ditempat yang paling tnudah sekali pun seperti praktek dokter. Bahan dan Cara Penelitian ini merupakan kohort yang didesign untuk mengetahui hubungan antara skor Selvester dan ketahanan hidup selama pengarnatan 6 bulan pada penderita IMA baru. Semua penderita IMA ham yang dirawat di ICCU RS Dr. Kariadi Semarang selama periode 3th2000- April 2003 dan memenuhi kriteria seleksi pada tahap pertama dilakukan pencatatan tentang: urnur dan jenis kelarnin; beberapa faktor predisposisi seperti merokok, diabetes melitus, hipertensi dan hiperkolesterolemia; beberapa komplikasi seperti ekstrasistol ventrikel maligtm, gagal jantung serta luas infark. Pada tahap kedua (pengarnatan 6 bulan) dilakukan evaluasi ketahanan hidup dan aktivitas hidup jika penderita masih hidup. Analisa statistik rnenggunakan kai kuasdrat, uji mutlak Fisher, 1 way-Anova dan analisa kesintasan metode Kaplan Meier dengan tingkat kemaknaaan p< 0,05. Hasil Selarna periode penelitian didapatkan 30 penderita 1MA yang memenuhi kriteria seleksi yang dirawat di ICCU RSUP Dr. Kariadi Semarang. Karakteristik penderita meliputi laki-laki 26 dan perempuan 4 orang. Umur antara 37-74 dengan rerata 55 + 8,85 tahun. Kebiasaan merokok 16 penderita, jumlah yang diisap antara 3-30 dengan rerata 10,56 ± 6,62 batang! had. Diabetes melitus 3, hipertensi 15, hiperkolesterolemia 5 dan gagal jantung 5 orang. Pada tahap pengamatan 6 bulan , 3 dad 5 penderita yang mengalami komplikasi gagal jantung selama perawatan meninggal. Uji statistik didapatkan adanya pengaruh gagal jantung terhadap ketahanan hidup secara berrnakna ()=0,02). Skor SOlvester dalam penelMan ini bola') dapat memberikan ramalan kematian (p=0,298). Kesimpulan Penilaian kuantitatif luas infark dengan metode skor Selvester belum dapat meyakinkan untuk rneramalkan kematian. Namun hubungan skor Selvester dengan ketahanan hidup secara diskriptive sudah dapat dijelaskan berdasar fungsi ventrikel kin.