Hubungan Kadar High Sensitivity C-Reactive Protein dengan Jumlah Lesi Arteri Koroner pada Pasien Sindroma Koroner Akut

Abstract

Introduction : Acute Coronary Syndrome (ACS) is one of the clinical manifestations of Coronary Heart Disease (CHD) that has high morbidity and mortality. Atherosclerosis is a process that underlies the occurrence of CHD. Inflammation plays an important role in the process of atherosclerosis. Prospective studies suggest that inflammatory markers high sensitivity of serum C-Reactive Protein (hs-CRP) are predictors of cardiovascular events. Through this study, it is expected to illustrate the relationship between hs-CRP levels and the number of coronary artery lesions in acute coronary syndrome patients who undergoing angiography examination. Aim : To determined the relationship of hs-CRP levels with the number of coronary artery lesions in patients with Acute Coronary Syndrome Methods : This was a cross-sectional study of 48 consecutive ACS patients who came to Adam Malik General Hospital Medan, from October to December 2018. Examination of hs-CRP levels, blood laboratory and coronary angiography were performed in each subject. Hs-CRP levels were divided into 2 groups based on the risk of cardiovascular events. The number of coronary artery lesions was assessed by Vessel Score. Furthermore, the results of serum hs-CRP are associated with Vessel scores using Chi-Square analysis. Results : From 48 research subjects, there were 16 (33.3%) subject with STEMI, NSTEMI and UAP respectively. Subjects in the hs-CRP group ≥ 3 mg/L as many as 15 (31.25%) subjects and the hs-CRP group <3 mg/L were 33 (68.75%) subjects, while based on Vessel scores, subjects with a Vessel score of 0, 1, 2, and 3 respectively 10 (20.8%), 12 (25%), 10 (20.8%), and 16 (33.3%) subjects. The mean hs-CRP level in patients with Vessel score of 0 (0.510 ± 0.203) mg/L, 1 (1,967 ± 0.729) mg/L, 2 (2,010 ± 0.689) mg/L, and 3 (5.388 ± 1,979) mg/L. In the Chi-Square analysis, there was a significant relationship between hs-CRP levels and Vessel score (p <0.001). Conclusion : There was a significant relationship between hs-CRP levels and the number of coronary artery lesions in ACS patients.

Latar Belakang : Sindroma Koroner Akut (SKA) merupakan salah satu manifestasi klinis Penyakit Jantung Koroner (PJK) yang mempunyai morbiditas dan mortalitas yang tinggi. Aterosklerosis merupakan proses yang mendasari terjadinya PJK. Inflamasi berperanan penting dalam proses terjadinya aterosklerosis. Studi prospektif menunjukkan bahwa marker inflamasi high sensitivity C-Reactive Protein (hs-CRP) serum merupakan prediktor kejadian kardiovaskular. Melalui penelitian ini diharapkan memberi gambaran hubungan kadar hs-CRP dengan jumlah lesi arteri koroner pada pasien SKA yang menjalani pemeriksaan angiografi. Tujuan : Mengetahui hubungan kadar hs-CRP dengan jumlah lesi arteri koroner pada pasien Sindroma Koroner Akut Metode : Penelitian cross sectional ini dilakukan di RSUP H. Adam Malik Medan pada bulan Oktober hingga Desember 2018 terhadap 48 pasien SKA. Dilakukan pemeriksaan kadar hs-CRP, laboratorium darah dan pemeriksaan angiografi koroner. Kadar hs-CRP dibagi atas 2 grup berdasarkan resiko kejadian kardiovaskular. Jumlah lesi arteri koroner dinilai dengan skor Vessel. Selanjutnya hasil hs-CRP serum dihubungkan dengan skor Vessel dengan menggunakan analisis Chi-Square. Hasil : Dari 48 subjek penelitian didapatkan subjek dengan STEMI, NSTEMI dan UAP masing-masing dengan besar sama sebanyak 16 (33,3%) orang. Subjek pada grup hs-CRP ≥ 3mg/L sebanyak 15(31,25%) orang dan grup hs-CRP <3 mg/L sebanyak 33(68,75%) orang, sedangkan berdasarkan skor Vessel, subyek dengan skor Vessel 0, 1, 2, dan 3 berturut-turut sebanyak 10 (20,8%), 12 (25%), 10 (20,8%), dan 16 (33,3%) orang. Rerata kadar hs-CRP pada pasien skor Vessel 0 (0,510±0,203) mg/L, 1 (1,967±0,729) mg/L, 2 (2,010±0,689) mg/L, dan 3 (5,388±1,979) mg/L. Pada uji analisis Chi-Square diperoleh korelasi yang signifikan antara kadar hs-CRP dengan skor Vessel (p < 0,001). Kesimpulan : Terdapat hubungan yang signifikan antara kadar hs-CRP dengan jumlah lesi arteri koroner pada pasien SKA.