Jurnal Impresi Indonesia (JII)

Vol. 4, No. 1, January 2025

p-ISSN: 2828-1284 e-ISSN: 2810-062x

website: https: //rivierapublishing.id/JII/ index.php / jii /index

Doi: 10.58344/jii.v4i1.6269

1080

gionina.amelia.halim8@gmail.com1, starry8888@yahoo.com2,

edmondleonardjim@unsrat.ac.id3

Cardiovascular diseases (CVDs) continue to be the leading cause of mortality worldwide,

with ischemic heart disease (IHD) being one of the most significant contributors (WHO, 2024).

The World Health Organization (WHO) estimates that CVDs are responsible for approximately

17.9 million deaths annually, accounting for 31% of all global deaths (Di Cesare et al., 2024).

A significant portion of these deaths results from acute coronary syndromes (ACS), particularly

myocardial infarctions, both ST-elevation myocardial infarctions (STEMI) and non-ST-

elevation acute coronary syndromes (NSTE-ACS) (Khan et al., 2020).

The Global Burden of Disease study in 2021 further highlights that ischemic heart disease

remains a primary contributor to mortality, with an estimated 9 million deaths per year

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

(Naghavi et al., 2024). This burden is not evenly distributed across the globe, as socio-

economic status, healthcare infrastructure, and access to preventive care significantly impact

(IHME, 2021). Additionally, urban populations are disproportionately affected, with lifestyle

changes and increasing prevalence of risk factors such as hypertension, diabetes, and obesity

contributing to the growing incidence of CVD (Rokom, 2021).

Among various types of ischemic heart disease, non-ST-elevation acute coronary

syndrome (NSTE-ACS) is a predominant concern due to its high morbidity and mortality. The

American College of Cardiology (ACC) notes that NSTE-ACS comprises approximately 70%

of all acute myocardial infarctions in the United States (ACC, 2024). In the United Kingdom,

the Myocardial Ischaemia National Audit Project (MINAP) recorded that out of 81,735 heart

including recurrent myocardial infarction, stroke, heart failure, and cardiovascular death

(Gupta et al., 2018; García-Blas et al., 2021). Studies suggest that aging exacerbates the decline

in LVEF, further increasing the risk of adverse outcomes (Houghton et al., 2016; NIH, 2024).

However, while age and LVEF are independently associated with MACE, their combined

impact on NSTE-ACS patients remains inadequately studied.

Given the increasing burden of NSTE-ACS and the significant role of LVEF in predicting

cardiovascular outcomes, it is imperative to explore the relationship between these factors to

improve patient prognosis. The urgency of this study is further underscored by the aging global

old, leading to a concurrent rise in age-related cardiovascular conditions (NIH, 2024).

with reduced LVEF had a higher likelihood of post-discharge mortality. Similarly, Siddiqui

and Holzmann (2019) demonstrated that among elderly patients with NSTE-ACS, those with

reduced LVEF had significantly higher long-term mortality rates. Another study by

Hendrickson et al. (2022) found that in STEMI patients, LVEF below 30% was associated with

increased hospital readmission and one-year mortality. Ferreira et al. (2021) further

emphasized the importance of mid-range ejection fraction (LVEF 40-49%), which is often

overlooked but carries an intermediate risk of MACE.

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

Additionally, age has been recognized as a major factor influencing cardiovascular

outcomes. Aging is associated with structural and functional changes in the cardiovascular

(Sherwood, 2017; Lilly, 2021). These changes contribute to a decline in cardiac efficiency,

exacerbating the impact of low LVEF. Studies have shown that older patients with ACS tend

to have worse outcomes due to a higher prevalence of comorbidities and reduced physiological

reserves (Okkonen et al., 2021; Lei et al., 2022).

Despite extensive research on the prognostic value of LVEF and the impact of aging on

cardiovascular health, limited studies have specifically examined the combined effect of these

factors on MACE incidence in NSTE-ACS patients. Previous research has predominantly

focused on STEMI patients, leaving a gap in the literature regarding NSTE-ACS (Toliu et al.,

models and potentially influence clinical guidelines for managing NSTE-ACS patients with

varying LVEF levels and age profiles.

By integrating evidence from global epidemiological studies, cardiovascular disease

burden reports, and clinical research on LVEF and aging, this study will provide valuable

insights into the prognosis of NSTE-ACS patients. The results will aid in the development of

targeted interventions to mitigate the risk of MACE and improve patient outcomes.

RESEARCH METHODS

This study is an observational analytic study with a retrospective cohort design, aiming

cardiovascular events at Prof. Dr. R. D. Kandou General Hospital during the period of January–

December 2023. The sample was selected using the consecutive sampling method, where

subjects were chosen based on meeting the inclusion criteria, including patients diagnosed with

NSTE-ACS and having complete data. Patients with incomplete data or lost to follow-up were

Data were collected from patient medical records, which included information such as

initials, age, gender, clinical diagnosis, left ventricular ejection fraction values, laboratory

results, therapies administered, and the occurrence of major cardiovascular events over six

months of observation. Data analysis was performed using the Chi-Square test and Fisher's

Exact test to determine the relationship between left ventricular ejection fraction and age with

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

the incidence of major cardiovascular events. This research methodology is designed to provide

a better understanding of the risk factors influencing major cardiovascular events, thereby

RESULTS AND DISCUSSION

SKA-NSTE patients at Prof. Dr. R. D. Kandou Manado Hospital from January to December

2023.

Young Adult (<55 yrs)

Older Adult (55-64 yrs)

Old-Young (65-74 yrs)Old-

Medium (75-84 yrs)

9 (10,6%)

24 (28,2%)

41 (48,2%)

10 (11,8%)

Male >45 years old & female >55

years old

Male gender

Family History

Early menopause

Smoke

Hypertension

Dyslipidemia

83 (97,6%)

60 (70,6%)

0 (0,0%)

0 (0,0%)

16 (18,8%)

63 (74,1%)

26 (30,6%)

0,506**

0,814***

0,782***

0,215***

1.000***

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

10 patients (62.5%) not experiencing KKM. There were 63 patients (74.1%) who had a history

of hypertension with 24 patients (28.2%) experiencing KKM and 39 patients (45.9%) not

(30.6%) with 11 patients (42.3%) experiencing KKM and 15 patients (57.7%) not experiencing

KKM. Meanwhile, for patients with diabetes mellitus, there were 33 patients (38.8%) with 17

patients (51.5%) experiencing KKM and 16 patients (48.5%) not experiencing KKM.

Kandou Manado Hospital for the January-December 2023 period are divided into 23 patients

with normal CK-MB levels (27.1%) and patients with high CK-MB levels as many as 62

patients (72.9%). From the group of patients with normal CK-MB levels, 12 patients (52.2%)

experienced KKM and 11 patients (47.8%) did not experience KKM. Meanwhile, in the group

patients at Prof. Dr. R. D. Kandou Manado Hospital during the period of January to December

2023 were classified into three categories, namely: patients with reduced left ventricle ejection

fraction, mildly reduced left ventricle ejection fraction, and preserved left ventricle ejection

fraction. The results showed that there were 39 patients (45.9%) with reduced left ventricle

ejection fraction, of which 23 patients (59%) experienced KKM, while 16 patients (41%) did

not experience KKM. In the mildly reduced left ventricle ejection fraction group, 20 patients

were found, with 8 patients (40%) experiencing KKM and 12 patients (60%) not experiencing

KKM. Meanwhile, there were 26 patients (30.6%) with preserved left ventricle ejection

fraction, of which 5 patients (19.2%) experienced KKM and 21 patients (80.8%) did not

experience KKM.

patients (56.6%), of which 16 patients (33.3%) experienced KKM and 32 patients (66.7%) did

not experience KKM. Meanwhile, the total revascularization group did not find patients

(0.0%).

given aspileps with 27 patients (38%) experiencing KKM and 44 patients (62%) not

experiencing KKM. 79 patients (92.9%) were given clopidogrel of which 34 patients (43%)

had KKM and 45 patients (57%) did not have KKM. 81 patients (95.3%) were given statins,

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

(88.2%) were given nitrates, of which 33 patients (44%) had KKM and 42 patients (56%) did

not have KKM. 59 patients (69.4%) were given ß-blockers, Among them, 23 patients (39%)

given ACE/ARB, of which 35 patients (43.2%) experienced KKM and 46 patients (56.8%) did

not experience KKM. 39 patients (45.9%) were given the antagonist aldosterone, of which 21

patients (53.8%) experienced KKM and 18 patients (46.2%) did not experience KKM.

Distribution of Major Cardiovascular Events in SKA-NSTE Patients at Prof. Dr. R. D.

Kandou Manado Hospital

Table 2. Distribution of Major Cardiovascular Events in SKA-NSTE

Patients at Prof. Dr. R. D. Kandou Hospital

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

Distribution of KKM in SKA-NSTE Patients at Prof. Dr. R. D. Kandou Manado Hospital

Based on Age Table 5. Distribution of KKM in SKA-NSTE Patients at Prof. Dr. R. D.

Kandou Manado Hospital Based on Age

11 (45,8%)

(65-74 years old), medium old (75-84 years old), and oldest old people (>85 years old). There

were 9 young adult patients (10.6%), of which 1 patient (11.1%) experienced KKM and 8

patients (88.9%) did not experience KKM. In the elderly adult category, there were 24 patients,

of which 11 patients (45.8%) experienced KKM and 13 patients (54.2%) did not experience

KKM. Patients with old age and young age were collected as many as 41 patients (48.2%) with

18 patients (43.9%) experiencing KKM and 23 patients (56.1%) not experiencing KKM.

Furthermore, in the old and medium category, there are 10 patients (11.8%), of which 6 patients

(60%) experience KKM and 4 patients (40%) do not experience KKM. The last category,

namely the oldest age, was found to be 1 patient (100%) and did not experience KKM.

Table 6. Distribution of KKM in SKA-NSTE Patients at Prof. Dr. R. D.

Kandou Manado Hospital Based on Age

2

18

(50,0%)

0

(16,7%)

0

Gionina Amelia Halim1, Starry Homenta Rampengan2, Edmond Leonard Jim3

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