Oxygen, although is highly required for living, can be toxic because it can be easily changed into oxygen free radicals (reactive oxygen species, ROS) and generates oxidative stress. [1][2][3][4][5] This oxidative stress will cause endothelial lesion and will be responded by endothelial cells through nitric oxide (NO) response and immunological response pathway. 6-8 The immunological response begins by increasing cytokines production, activated coagulation factors, and reactivation of platelet in acute thrombotic process. However, acute thrombotic process, which is an initial part of protective mechanism to fix the lesion, often change to become continuous process because of abundance oxidative stress, and then generates various levels of acute coronary syndromes. 3,5 Several studies showed that acute exercise on treadmill test with high intensity Bruce protocol increased oxidative stress because of ROS. 9,10 On the contrary, acute exercise also increased production of NO because of the increment effect of shear stress on endothelial cells. 6,9-15 But, regular exercise Keywords ► acute coronary syndrome ► atherosclerosis ► cardiovascular risk factors ► myocardial infarction ► oxidative stress ► nitric oxide ► cardiac markers ► exercise AbstractModerate-to-high intensity of exercise training within 2 to 3 months decreases oxygen free radicals (reactive oxygen species, ROS) and increases nitric oxide (NO) in outpatients with myocardial infarction. There is no data about the association of ROS and NO after short-term low-intensity exercise training within 5 days in patients hospitalized with acute myocardial infarction (AMI). A total of 32 male patients with AMI were randomized into two groups: 15 patients with short-term low-intensity exercise training within 5 days formed the training group and 17 patients without such exercise training formed the control group. All patients performed exercise treadmill test with modified Bruce protocol before and after the study. F2-isoprostane and NO concentration of the training group increased slightly after modified Bruce exercise treadmill test. Compared with the control group, NO of the training group was also slightly higher. Baseline NO and uric acid were negative predictor variables for F2-isoprostane in all patients hospitalized with AMI, and triglyceride was a positive predictor variable. After the study, physical capacity of the training group was higher; but heart rate and systolic blood pressure were lower significantly. This study showed that short-term low-intensity exercise training for patients hospitalized with AMI did not change ROS and NO productions, but it improved physical capacity and lowered heart rate and systolic blood pressure. NO was negative predictor variable for F2-isoprostane in controlling ROS changes in dynamic compensation mechanism.
Aim: To document current usage of antiplatelet therapy and the implementation of ACC/AHA 2007 guideline in the clinical management of unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients not undergoing PCI procedure in Indonesia (medically managed) and their risks according to Global Registry of Acute Coronary Events (GRACE) score as well as in-hospital mortality. Method: A multicenter observational, prospective disease registry, recruiting patients with UA/NSTEMI. No specific treatment will be recommended in this disease registry. Data will be collected based on Physician's applicable daily practices without any intervention. Results: A total of 467 eligible patients, 246 patients with UA and 221 with NSTEMI, aged 18 years or older were recruited from 18 hospitals during December 2009 -January 2011. Most recruited patients were at low risk (63.9%) and only 0.9% patients were at high risk according to the GRACE score. Patients were treated with ASA (90.6%) and Clopidogrel (96.6%) when they reached the emergency department. Medical therapy instituted during hospitalization were injectable anticoagulant (91.4%), oral anticoagulant (0.9%), oral nitrate (82.7%), beta blocker (60.8%), ACE inhibitor (49%), angiotensin receptor blocker (20.3%), calcium channel blocker (19.9%), statin (13.1%), and other medications given according the presentation of complications or comorbidities. In-hospital mortality was documented in 3.2% of patients. At discharge ASA was given to 87.6% and clopidogrel to 94.2% patients. Conclusion: The result showed that most of the patients admitted with UA/NSTEMI were at low or moderate risk according to GRACE score. Although treatment with antiplatelet and anticoagulant largely followed the ACC/AHA guidelines, however, this registry documented under treatment of other medications such as ACE-inhibitors and beta blockers. Reinforcement of the guideline compliance and continuous medical education would provide better outcomes for the patients.(J Kardiol Indones. 2015;36:130-7)Tujuan: Registri ini utamanya bertujuan melakukan dokumentasi terhadap pasien yang mendapatkan terapi antiplatelet dan implementasi pedoman tatalaksana klinis dari ACC/AHA bagi pasien angina tidak stabil/infark miokard tanpa elevasi segmen ST yang tidak menjalani terapi reperfusi di Indonesia (Medically Managed Registry). Tujuan tambahan adalah mengetahui tingkat risiko pasien berdasarkan Global Registry of Acute Coronary Events (GRACE) dan tingkat kematian selama perawatan di rumah sakit. Metodologi: Registri prospektif dan multi-senter dengan cakupan pasien yang telah terdiagnosis angina tidak stabil/infark miokard tanpa elevasi segmen ST yang tidak menjalani terapi reperfusi. Registri ini tidak merekomendasikan intervensi apapun. Data dicatat sesuai praktik dokter yang merawat. Hasil: Dari 18 rumah sakit di Indonesia, selama periode Desember 2009 sampai dengan Januari 2011, tercatat 467 pasien yang mempunyai kesesuaian dengan inklusi dan eksklusi, terdiri dari 246 pasien dengan angina tidak stabil da...
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