ACI (Acta Cardiologia Indonesiana)

Differences in Coronary Grade Flow in Diagnostic Coronary Angiography Between Half Dose and Full Dose Pharmacoinvasive Strategy in Patients with ST-Elevation Myocardial Infarction (STEMI)

2026-07-01T11:24:39+07:00

Background: The time for managing patient with STEMI undergoing primary PCI strategy in indonesia has not yet achieved the ideal target < 90 minutes. Considering the risk of bleeding from fibrinolysis strategy, despite being part of the pharmacoinvasive strategy. Half dose pharmacoinvasive strategy was developed to address these limitations and its expected to give the same result as full dose pharmacoinvasive strategy

Objectives: To determine the diferences in coronary grade flow in diagnostic coronary angiography procedure between half dose pharmacoinvasive strategy and full dose pharmacoinvasive strategy in patients with STEMI

Methods: This study is an observational study with retrospective cohort design to determine the differences in coronary flow grade in diagnostic coronary angiography procedure between half dose pharmacoinvasive strategy and full dose pharmacoinvasive strategy in patients with STEMI using secondary data from SHERIVE study between February 2021 until march 2025. Coronary flow grade was assessed based on diagnostic coronary angiography and grouped into TIMI grade 3 flow as coronary flow patency dan TIMI grade 0-2 flow (not TIMI grade 3 flow)

Result: There were 151 subjects who met the inclusion and exclusion criteria: 75 subjects in the half dose pharmacoinvasive strategy and 76 subjects in full dose pharmacoinvasive strategy. Bivariate analysis showed a significant difference in the degree of TIMI grade 3 flow between the half dose pharmacoinvasive strategy and the full dose pharmacoinvasive strategy, 33.33 % vs 52.63 % respectively (RR 0,633; IK 95 % 0,431-0,930;p=0,017). Multivariate analysis also found that the halfdose pharmacoinvasive strategy was an independent predictor of TIMI grade 3 flow (RR 0.377; 95% CI 0.185-0.765; p=0.007). Other independent predictors of achieving TIMI grade 3 flow included administration of ACE inhibitors/ARBs (RR 0.303; 95% CI 0.141-0.654; p=0.002)

Conclusion: There is a significant difference in TIMI grade 3 flow in diagnostic coronary angiography procedure between patients with STEMI undergoing half dose pharmacoinvasive strategy and full dose pharmacoinvasive strategy.

ASSOCIATION OF MICRO RIBONUCLEIC ACID (miRNA) 654-5P EXPRESSION WITH COLLATERAL DEGREE IN CHRONIC LIMB THREATENING ISCHEMIA

2026-07-06T09:58:21+07:00

Background: Chronic Limb-Threatening Ischemia (CLTI) represents most severe form of chronic peripheral arterial disease, which is associated with poor clinical outcomes if left untreated. Despite advances in interventional and pharmacological therapies, peripheral arterial disease remains a major public health issue. Several studies have reported that miRNA play a role in arteriogenesis through multiple signaling pathways. One of the novel miRNAs identified through profiling studies is miRNA 654-5p. However, literature specifically analysing miRNA 654-5p as a biomarker and its association with CLTI remains very limited, and no previous studies have linked its expression levels with the degree of collateral formation in CLTI.

Objectives: The primary objective of this study was to analyze the difference in miRNA 654-5p expression between patients with and without CLTI, as well as according to the degree of collateral formation among patients treated at Dr. Sardjito General Hospital. The secondary objective was to determine the differences in collateral degree based on age, sex, hypertension, diabetes mellitus, smoking status, dyslipidemia, and chronic kidney disease.

Methods: This was an analytical observational study with a cross-sectional design using secondary data from a previous study by Ismail et al. (2025), conducted from February to October 2023. The study included adult patients diagnosed with CLTI according to the 2019 ESVS Guidelines on the Management of Chronic Limb-Threatening Ischemia. These subjects had undergone arteriography and blood sample was taken for miR-654-5p expression analysis.

Results: A total of 33 subjects were included, consisting of two groups: CLTI (n = 15) and non-CLTI (n = 18). miRNA 654-5p expression was found to be upregulated with a fold change value of 3.45. The ROC curve analysis yielded an AUC of 57%, with an optimal cut-off point based on the Youden index was 28.56 with 80% sensitivity and 50% specificity (p = 0.492, 95% CI 0.370–0.771). Based on this cut-off, there was no statistically significant association between miRNA 654-5p expression and the presence of CLTI (OR 4; 95% CI 0.835–19.162; p = 0.74). However, a significant difference was found between miRNA 654-5p expression and collateral grade (p = 0.001). On bivariate analysis, the association between collateral grade and confounders were not statistically significant.

Conclusion: miRNA 654-5p expressions were higher in subjects with CLTI, although with weak statistical power. Higher miRNA 654-5p expression were higher in subjects with a worse collateral grade.

Exploring the Efficacy of Renal Denervation in Chronic Kidney Disease Patients with Resistant Hypertension: A Systematic Review

2026-07-06T09:59:26+07:00

Introduction: Resistant hypertension, affecting 30–40% of chronic kidney disease (CKD) patients, accelerates renal deterioration and is often unresponsive to pharmacological treatment. Renal denervation (RDN) has emerged as a promising intervention; however, its efficacy and safety in CKD patients remain inconsistently reported. This systematic review evaluates the role of RDN in reducing blood pressure among CKD patients with resistant hypertension.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane databases until March 2025 using PRISMA 2020 guidelines. Eligible studies included CKD patients who underwent RDN with outcomes measuring blood pressure reduction. The Cochrane RoB 2.0 tool was used to assess the risk of bias in included studies.

Results: We included a total of 9 studies showing low-moderate risk of bias, originating from various countries worldwide. Despite employing different blood pressure measurement techniques, all studies favor the use of renal denervation in decreasing mainly systolic blood pressure.

Discussion: The results support the efficacy of RDN in significantly lowering systolic blood pressure in CKD patients with resistant hypertension. Additionally, some studies indicated potential renal benefits and minimal safety concerns. However, differences in RDN techniques, CKD stages, and follow-up durations limit direct comparison and generalizability of results.

Conclusion: RDN appears to be a safe and effective adjunct therapy for resistant hypertension in CKD patients. Further large-scale, standardized trials are necessary to confirm long-term outcomes and refine patient selection criteria.

Left Atrial Myxoma with Secondary Tricuspid Regurgitation in A Peripheral Hospital: A Case Report and Literature Review

2026-07-06T09:58:56+07:00

Background: Cardiac myxoma, a rare disease of the heart, counts as the most common benign cardiac tumor. Around 75% arises in the left atrium. In peripheral hospital, where advanced imaging is often unavailable, diagnosis depends largely on clinical manifestation and transthoracal echocardiography.

Case Presentation: We present a 44-year-old female with progressive exertional shortness of breath for one month, palpitations, leg swelling, productive cough, and weakness. She had a history of an enlarged heart. Examination revealed tachycardia, a holosystolic murmur in the left lower sternal border, and bilateral pedal edema. Electrocardiography showed biatrial enlargements. Transthoracic echocardiography (TTE) demonstrated a left atrial mass sized 6.5 cm x 3.0 cm, severe tricuspid regurgitation, and left ventricle diastolic dysfunction. She was stabilized in our intensive care unit and subsequently referred to a higher-level hospital 30 hours later.

Discussion: In this patient, the myxoma swings into the mitral valve opening blocking blood flow from left atrium to left ventricle. This obstruction creates high pulmonary pressure, leading to right ventricular dilatation over time, which results in functional tricuspid regurgitation. Myxoma ideally requires prompt excision due to high risk of embolism and complete obstruction.

Conclusion: This case highlights the importance of careful physical examination and transthoracic echocardiography, as delayed diagnosis increases morbidity and mortality.

Management and Closure Strategies for Atrial Septal Defect with Bidirectional Shunt and Pulmonary Arterial Hypertension: A Comprehensive Review of the Paradigm Shift Toward Reverse Remodelling

2026-07-06T09:55:43+07:00

Atrial septal defect (ASD) complicated by severe pulmonary arterial hypertension (PAH) and bidirectional shunting represents a critical clinical challenge in adult congenital heart disease. Traditionally, these patients were often deemed inoperable due to the perceived irreversibility of pulmonary vascular disease and the high risk of acute right heart failure following defect closure. However, recent advances in pharmacological therapy and interventional techniques have catalysed a significant paradigm shift from "Treat and Repair" to "Repair and Treat," emphasizing the biological potential for reverse remodelling of the pulmonary vasculature. This comprehensive review examines the physiological mechanisms of reverse remodelling, diagnostic challenges including invasive hemodynamic assessment, and the strategic use of fenestrated closure devices. By synthesizing contemporary clinical data and longitudinal outcomes, we provide a robust framework for optimizing survival and functional outcomes in this high-risk population.