Interval T Peak – T End pada Elektrokardiogram sebagai Penanda Keberhasilan Reperfusi Pasien Infark Miokard Akut Elevasi Segmen ST yang Menjalani Terapi Fibrinolitik di Rumah Sakit Haji Adam Malik Medan

Abstract

Latar Belakang : Target utama penatalaksanaan IMA-EST adalah terapi reperfusi segera, dalam 12 jam pertama onset dapat dilakukan dengan IKP primer ataupun fibrinolitik. Walaupun efektifitas IKP primer lebih unggul, terapi fibrinolitik memiliki kelebihan dalam hal ketersediaan dan sumber daya sehingga risiko delay menjadi lebih rendah. Penilaian keberhasilan fibrinolitik sangat penting untuk dasar keputusan selanjutnya, resolusi segmen ST menggambarkan perfusi miokardial dan punya makna klinis yang lebih baik. Interval T peak dan T end (Tpe) merefleksikan transmural dispersion of repolarization (TDR) yang dapat menjadi alternatif dan tambahan penilaian reperfusi. Penelitian ini bertujuan untuk mengetahui penurunan interval Tpe dapat menjadi penanda keberhasilan reperfusi pasien IMA-EST yang menjalani terapi fibrinolitik, sehingga diharapkan dapat menjadi alat bantu dan bahan pertimbangan tambahan dalam tatalaksana kasus sehari-hari. Metode : Penelitian potong lintang ini melibatkan 86 pasien IMA-EST onset ≤ 12 jam yang menjalani terapi fibrinolitik sejak periode oktober 2017 hingga juli 2021 di RSUP H. Adam Malik Medan. Interval Tpe dan cTpe [jarak RR(s)/√Tpe (ms)] diukur sebelum dan 90 menit sesudah fibrinolitik kemudian perubahannya berupa selisih (ms) dan resolusi (%) dihubungankan dengan indikator keberhasilan reperfusi yang dinilai dengan resolusi segmen ST. Analisis statistik dilakukan dengan menggunakan uji beda dua rerata dan receiver operating curve (ROC). Hasil : Dari total 86 pasien, 53 pasien (61.2%) termasuk dalam kelompok keberhasilan reperfusi. Penurunan nilai interval Tpe dan cTpe lebih besar dijumpai pada kelompok keberhasilan reperfusi. Selisih Tpe dan cTpe memiliki sensitivitas 66% dan spesifisitas 75.8% dengan nilai area under curve (AUC) dan cut-off masing-masing sebesar 72.6% dan 20 ms ; 71.5% dan 20.02 ms. Sedangkan resolusi Tpe & cTpe masing-masing sebesar 72.6% dan 16.2% ; 73.7% dan 16.2% dengan sensitivitas 66% dan spesifisitas 72.7%. Kesimpulan : Penurunan interval Tpe dan cTpe dapat menjadi penanda keberhasilan reperfusi pasien IMA-EST yang menjalani terapi fibrinolitik. Resolusi cTpe memiliki nilai AUC yang paling baik dalam memprediksi keberhasilan reperfusi.

Background : The goal of STEMI treatment is immediate reperfusion therapy, in the first 12 hours of onset it can be achieved either with primary PCI or fibrinolytic. Although the superiority of effectiveness with primary PCI, fibrinolytic has advantages in terms of availability and resources so that the risk of delay is lower. Assesment of succesfull fibrinolytic is the key to base further decisions, ST segment resolution reflects myocardial perfusion and has better clinical values. T peak and T end (Tpe) interval reflects transmural dispersion of repolarization (TDR) which can be an alternative and additional assessment of reperfusion. This study aims to determine if Tpe interval can be a marker of successful reperfusion in patients with STEMI undergoing fibrinolytic therapy. Method : This is a crossectional study involving 86 patients with STEMI ≤ 12 hours undergoing fibrinolytic treatment from october 2017 untill july 2021 in Adam Malik Hospital Medan. Tpe and cTpe [RR (s)/√Tpe (ms)] interval were measured before and after fibrinolytic treatment and then the changes in the form of difference (ms) and resolution (%) were associated with indicator of successful reperfusion as assessed by ST segment resolution. Statistical analysis was performed using t-test and receiver operating curve (ROC). Results : Among 86 patients, 53 patients (61.2%) were included in the successful reperfusion group. The decrease in the value of Tpe and cTpe was greater in the successful reperfusion group. The difference of Tpe and cTpe has a sensitivity of 66% dan specificity of 75.8% with area under curve (AUC) and cut-off values of 72.6% and 20 ms ; 71.5% and 20.02 ms, respectively. While the resolution of Tpe and cTpe were 72.6% and 16.2% ; 73.7% and 16.2%, respectively with sensitivity of 66% and specificity of 72.7%. Conclusions : The Tpe and cTpe interval reduction can be a marker of successful reperfusion in patients with STEMI treated with fibrinolytic therapy. The cTpe resolution has the best AUC value in predicting successful reperfusion.