Ika Prasetya Wijaya

GALECTIN-3: A NOVEL BIOMARKER FOR THE PROGNOSIS OF HEART FAILURE

Heart failure (HF) is still a global burden which carries substantial risk of morbidity and mortality. Thus, appropriate approach of diagnosis and layering the prognosis of HF are of great importance. In this paper we discuss and review a novel biomarker, which is called galectin-3 and already approved by Food and Drugs Administration (FDA) as a prediction tool for HF. Galectin-3, which is secreted by macrophages under the influence of mediators like osteopontin, has been known for its significant role in mediating cardiac fibrosis and inflammation. Numerous studies have shown galectin-3 as a novel prognostic biomarker with high predictive value for cardiovascular mortality and re-hospitalization in HF patients. However, there are also other contradictive studies displayed galectin-3 inferiority against other existed HF prognostic biomarkers like NT-proBNP and ST2. Nevertheless, galectin-3 has some advantages such as more stability and resistance against hemodynamic loading and unloading state, and also it could act as an early indicator of cardiac fibrosis, ventricular remodeling, and renal impairment in HF patients.

Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry

Objective We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design Retrospective cohort study. Setting Emergency department of 56 health centres. Participants 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure Characteristics of reperfusion therapy. Results The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. Trial registration number NCT02319473.

Diagnostic Test of Platelet Lymphocyte Ratio for Screening of Complex Coronary Lesion in Different Age Group of Acute Coronary Syndrome

Background: Increasing of ACS case with complex coronary lesion and in increase needs of CABG, we need tools to help in stratification of high risk patient that can be used in daily clinical practice, and even can be used in first line of health care facilities in Indonesia. By doing early stratification of high risk patient, hopefully it can decrease the morbidity and mortality in ACS cases. Aim: Evaluate diagnostic accuracy of PLR in identifying a complex coronary lesion and optimal cut-off point of PLR between ≤ 45 years old group and >45 years old group subjects. Method: This is a cross sectional study which was conducted retrospectively in ACS patients from January 2012 until July 2015. The inclusion criteria are adult ACS patients (age ≥18 years old) diagnosed with ACS and who underwent coronary angiography during hospitalization. The diagnostic accuracy was determined by calculating the sensitivity, specificity, Positive Likelihood Ratio (LR+), and Negative Likelihood Ratio (LR-). The cut-off point was determined using ROC curve. Results: The proportion of complex coronary lesion in this study was 47.2%. The optimal cut-off point in ≤ 45 year’s old group was 111.06 with sensitivity, specificity, LR+, and LR─ respectively 91.3%, 91.9%, 11.27 and 0.09. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity, specificity, LR+, and LR─ respectively 91.7%, 58.6%, 2.21 and 0.14. Conclusion: The optimal cut-off point of ≤ 45 years old groups is 111.06 and for >45 years old group is 104.78 with AUC 93.9% (p<0.001) 77.3% (p<0.001), respectively.