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All Journal Heart Science Journal
Lutfi Hafiz Zunardi
Brawijaya University
Health Professions Immunology & microbiology Medicine & Pharmacology

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How to deal with LM Disease in NSTEMI patient: PCI or CABG? Lutfi Hafiz Zunardi; Mohammad Saifur Rohman; Budi Satrijo; Adriawan Widiya Nugraha
Heart Science Journal Vol 4, No 2 (2023): Dealing with the Complexity of the Wide Spectrum of Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.02.6

Abstract

 Background: The left main coronary artery (LMCA) with acute coronary syndrome have been associated with significant morbidity and mortality. Urgent CABG is recommended for patients with LM disease accompanied by ACS, but requires special preparation and adequate facilities. not all hospitals are ready. PCI on left main coronary artery is a high risk procedure which requires special preparation like IVUS and FFR. Meanwhile, the ACS case is an emergency that needs to be treated immediately. Interventional management is mandatory in this setting, but the concern is whether the action is carried out in an emergency or an elective procedure.Objective: This study aimed to describe the management of LM disease in NSTEMI patients.Case presentation: We will discuss a 69-year-old male brought to our hospital because of chest pain while doing moderate activity. The patient was previously referred from a private hospital and was assessed as NSTEACS. from angiography there was Stenosis dd Thrombus at LM, the cardiologist suggest him to be referred to RSSA for CVCU admission and will be underwent Urgent revascularisation. Clopidogrel and aspirin were routinely consumed as dual antiplatelet therapy. We treat the patient with an unfractionated heparin (UFH) bolus, continued with continuous infusion until revascularization. No event of subsequent acute coronary syndrome was observed.Conclusion: Although the management of patients with LM disease requires some preparation before action is taken, urgent revascularization in Acute coronary syndrome cases must still be carried out immediately.
Neutrophil-Lymphocyte Ratio (NLR) as A Predictor for Non-ST Elevation Myocardial Infarction (NSTEMI) in the Emergency Room Lutfi Hafiz Zunardi; Setyasih Anjarwani; Indra Prasetya; Budi Satrijo; Anna Fuji Rahimah
Heart Science Journal Vol 5, No 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.7

Abstract

AbstractBackground: The usefulness of the NLR as an approach to identifying cases of acute coronary syndrome (ACS) needs to be improved.Objective: This research was designed to determine the effectiveness of the NLR in identifying individuals who presented to the emergency room complaining of anginal due to ACS.Methods: The single-center cross-sectional study was performed at Saiful Anwar General Hospital in Malang, East Java, Indonesia, from July 2020 to December 2023. Patients were involved in this study with complaints of angina suspected of ACS. During further observation in the emergency room, based on the findings of the troponin I analysis, individuals were divided into unstable angina pectoris (UAP) and NSTEMI.Results: Study results were collected from 282 individuals diagnosed with Non-ST Elevation Acute Coronary Syndrome (NSTEACS), with 75.9% male and a mean age of 58.39 ± 10.27 years. The NLR threshold was 4.5 (AUC: 0.78, 95% CI: 0.765–0.867, P <.001) assessed during admission, which showed a sensitivity of 79% and a specificity of 78% in accurately predicting the probability of subsequent troponin positivity. Multivariate analysis revealed that the NLR at hospitalization remained an essential marker of troponin positivity during follow-up.Conclusions: In the end, NLR could be considered an initial test in emergency services to predict the diagnosis of NSTEMI in people experiencing angina. 
Co-Authors Adriawan Widiya Nugraha Anna Fuji Rahimah Budi Satrijo Budi Satrijo Indra Prasetya Mohammad Saifur Rohman Setyasih Anjarwani