Perbandingan Skor Cami-Nstemi dan Grace sebagai Prediktor Kejadian Kardiovaskular Mayor Selama Rawatan Infark Miokard Akut Non ST Elevasi (Ima-Nest)

Abstract

Background : Risk Stratification has a role in the management of patients with a diagnosis of NSTEMI. GRACE score was a widely used and validated score in risk stratification, although has various drawbacks, particularly in the assessment of Asian populations. CAMI-NSTEMI score, which was generated in China, was representative of the Asian population in its study. This study compared the ability of CAMI-NSTEMI and GRACE score in the assessment of inhospital Major Cardiovascular Events (MACEs) in North Sumatra. Method : A total of 100 patients hospitalized with a diagnosis of NSTEMI at Haji Adam Malik General Hospital, Murni Teguh Hospital, and Grandmed Hospital were included in the study. Data recording of history, examination, ECG, Laboratory was carried out, then followed up to assess inhospital MACEs. The AUC values of each score were compared. AUC assessment was also performed for each type of MACEs: mortality, heart failure, arrhythmias and cardiogenic shock. Result : Major cardiovascular events in hospitalization were recorded in 38% of patients, of which mortality was in 7%, incidence of heart failure in 35%, arrhythmias in 2% and cardiogenic shock in 8% of patients. AUC values for MACEs on each CAMI-NSTEMI and GRACE scores were 87.4% and 92.2%, respectively. In terms of mortality, heart failure, and cardiogenic shock, the results were respectively: 94.5% vs. 94.4%; 86.3% vs. 88.9%; 99.1% vs. 97.8%. The relationship between the two scores with the incidence of arrhythmias was found to be statitically insignificant so that comparative analysis could not be carried out. Conclusions : The GRACE score has slightly better predictive value for MACEs during hospitalization compared to the CAMI-NSTEMI score. This study suggests the use of the CAMI-NSTEMI score as an alternative to the GRACE score in Asian population. The CAMI-NSTEMI score was slightly superior in predicting mortality and the incidence of in-hospital cardiogenic shock.

Latar Belakang : Stratifikasi Resiko memiliki peranan dalam manajemen pasien dengan diagnosis IMA-NEST. Skor GRACE adalah skor yang telah digunakan dan tervalidasi secara luas dalam stratifikasi resiko, namun skor ini memiliki berbagai kekurangan, khususnya dalam penilaian populasi Asia. Skor CAMINSTEMI, yang dibuat di Cina, merepresentasikan populasi Asia dalam pembuatannya. Penelitian ini membandingkan kemampuan skor CAMI-NSTEMI dan GRACE dalam penilaian Kejadian Kardiovaskular Mayor (KKVM) di Sumatera Utara. Metode : Sebanyak 100 pasien dalam rawatan dengan diagnosis IMA-NEST di RSUP Haji Adam Malik, RS Murni Teguh, dan RS Grandmed dimasukkan dalam penelitian. Pencatatan data anamnesis, pemeriksaan, EKG, Laboratorium dilakukan, lalu diikuti untuk menilai KKVM selama rawatan. Nilai AUC dari masing-masing skor dibandingkan. Penilaian AUC juga dilakukan untuk jenis KKVM masing-masing seperti mortalitas, gagal jantung, aritmia dan syok kardiogenik. Hasil : Kejadian kardiovaskular mayor dalam rawatan tercatat pada 38% pasien, dimana mortalitas pada 7%, kejadian gagal jantung pada 35%, aritmia pada 2 % dan syok kardiogenik pada 8% pasien. Nilai AUC untuk KKVM skor CAMINSTEMI dan GRACE masing-masing 87,4% dan 92,2%. Dalam hal kejadian mortalitas, gagal jantung, dan syok kardiogenik, didapati hasil masing-masing: 94,5% vs 94,4%; 86,3% vs 88,9%; 99,1% vs 97,8%. Hubungan kedua skor dengan kejadian aritmia didapati nilai tidak signifikan sehingga tidak dapat dilakukan analisa perbandingan. Kesimpulan : Skor GRACE memiliki kemampuan sedikit lebih baik dalam memprediksi KKVM selama rawatan dibanding Skor CAMI-NSTEMI. Studi ini menyarankan penggunaan skor CAMI-NSTEMI sebagai alternatif terhadap skor GRACE pada populasi Asia. Skor CAMI-NSTEMI sedikit lebih unggul dalam memprediksi mortalitas dan kejadian syok kardiogenik selama rawatan.