Hubungan Kadar High Sensitivity -C Reactive Protein dengan Derajat Stenosis Arteri Koroner pada Pasien Angina Pektoris Stabil

Abstract

Abstract The Correlation Between High Sensitivity - C Reactive Protein Levels and Severity of Coronary Artery Stenosis in Patients with Stable Angina Pectoris Johannes Purba, Zainal Safri, Refli Hassan Cardiology Division Internal Medicine Department Faculty of Medicine University of Sumatera Utara H. Adam Malik General Hospital Medan Background Coronary Heart Disease (CHD) remains a serious health problem and has a number of high morbidity and mortality. Atherosclerosis is the underlying cause of CHD event. Inflammation has an important role in the process of atherosclerosis. Prospective studies show that the inflammatory marker high sensitivity - C Reactive Protein (hs-CRP) serum is a predictor of cardiovascular events. It is debatable whether increased level of hs-CRP associated with severity of coronary artery stenosis degree comfirmed by angiography examination. Objective : To determine the correlation between increased levels of serum hs-CRP and severity of coronary artery stenosis degree in patients with stable angina pectoris. Materials and Methods : This was a cross-sectional study. Subjects with stable angina pectoris were examined serum hs-CRP, blood laboratory and coronary angiography. Serum hs- CRP levels were divided into 3 groups based on the risk of cardiovascular events according to the American Heart Association and Centers for Disease Control (AHA/CDC) 2003. The degree of severity coronary artery stenosis assessed by vessel score, consist of 0-3 points based on number of main coronary artery stenosis ≥ 50%. Furthermore, the serum levels of hs-CRP correlated with vessel score. Result : A total number of 35 subjects with stable angina pectoris, there were 7 subjects with non CHD (score 0) with mean (± SD) levels of serum hs-CRP were 1,21 ± 0,56 mg/L while subjects with CHD (score 1, 2, 3), there were 10 (28,6%), 8 (22,8%) and 10 (28,6%) subjects respectively with mean (± SD) levels of serum hs-CRP were 1,68 ± 1,26 mg/L, 2,59 ± 1,48 mg/L dan 4,41 ± 1,91 mg/L. There was a statistically significant positive correlation between increased levels of serum hs-CRP and vessel score using Spearman correlation (r = 0,667, p= 0,0001). Conclusion : There was a correlation between increased levels of serum hs-CRP with vessel score. The higher level of serum hs-CRP has strongly correlation with the degree of coronary artery stenosis. Hs-CRP can be use to predict the condition of severity coronary artery stenosis in patients with stable angina pektoris. Key Word : stable angina pectoris, hs-CRP, severity coronary artery stenosis

Abstrak ”Hubungan Kadar High Sensitivity - C Reactive Protein Dengan Derajat Stenosis Arteri Koroner Pada Pasien Angina Pektoris Stabil” Johannes Purba, Zainal Safri, Refli Hassan Divisi Kardiologi Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara RSUP.H.Adam Malik Medan Latar Belakang Penyakit Jantung Koroner (PJK) masih merupakan masalah kesehatan yang serius dan mempunyai angka morbiditas dan mortalitas yang tinggi. Aterosklerosis merupakan dasar penyebab 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 terhadap kejadian kardiovaskular. Masih menjadi perdebatan apakah peningkatan kadar hs-CRP serum berhubungan dengan derajat keparahan stenosis arteri koroner yang dibuktikan dari pemeriksaan angiografi. Tujuan : Untuk mengetahui apakah peningkatan kadar hs-CRP serum berhubungan dengan derajat keparahan stenosis arteri koroner pada pasien angina pektoris stabil Bahan dan Cara : Penelitian observasional dengan metode pengukuran cross-sectional. Subjek dengan angina pektoris stabil, dilakukan pemeriksaan hs-CRP dan laboratorium darah serta pemeriksaan angiografi koroner. Kadar hs-CRP serum dibagi atas 3 grup berdasarkan resiko kejadian kardiovaskular menurut American Heart Association dan Centers for Disease Control (AHA/CDC) 2003. Derajat keparahan stenosis arteri koroner di nilai dengan skor vessel yang terdiri dari 0-3 poin berdasarkan jumlah arteri koroner utama yang mengalami stenosis ≥ 50%. Selanjutnya hasil hs-CRP serum dihubungkan dengan skor vessel. Hasil : Dari 35 subjek penelitian dimana subjek yang tergolong non PJK dengan skor 0 sebanyak 7 (20%) orang dengan rerata kadar hs-CRP serum 1,21 ± 0,56 mg/L sedangkan yang tergolong PJK yang terdiri dari skor 1, 2 dan 3 sebanyak 10 (28,6%), 8 (22,8%) dan 10 (28,6%) orang berturut-turut dengan rerata kadar hs- CRP serum 1,68 ± 1,26 mg/L, 2,59 ± 1,48 mg/L dan 4,41 ± 1,91 mg/L berturutturut. Pada uji korelasi Spearman diperoleh hubungan linier positif yang signifikan antara skor vessel dengan peningkatan kadar hs-CRP serum (r= 0,667 dengan p= 0,0001) Kesimpulan : Didapatkan hubungan peningkatan kadar hs-CRP serum dengan skor vessel. Semakin tinggi kadar hs-CRP serum, semakin banyak arteri koroner yang mengalami stenosis ≥ 50 %. Pemeriksaan hs-CRP dapat digunakan untuk memprediksi keadaan keparahan stenosis arteri koroner yang terjadi pada pasien angina pektoris stabil. Kata Kunci : angina pektoris stabil, hs-CRP, keparahan stenosis arteri koroner