ABSTRAK
Latar belakang : Insiden infark miokard akut sebagai salah satu bentuk dari penyakit jantung koroner (PJK) semakin meningkat. Reperfusi sebagai terapi definitif bertujuan untuk melancarkan kembali aliran darah dan memperbaiki fungsi endotel. Telah banyak penelitian yang mengamati pemberian terapi tambahan sebelum tindakan reperfusi untuk meningkatkan fungsi endotel. Statin sebagai terapi pilihan penurun lipid memiliki efek pleiotropik yang telah terbukti meningkatkan fungsi endotel. Pemberian statin sebelum tindakan intervensi koroner perkutan primer terbukti meningkatkan kadar nitric oxide (NO). Data mengenai pemberian statin sebelum tindakan fibrinolisis masih kurang.
Tujuan : Untuk mengetahui pengaruh pemberian atorvastatin 80 mg segera sebelum tindakan fibrinolisis terhadap kadar NO pada pasien infark miokard akut dengan elevasi segmen ST.
Metode : Jenis penelitian ini adalah penelitian eksperimen dengan Randomized Controlled Trial. 30 pasien dengan infark miokard akut yang dilakukan tindakan fibrinolisis di ruang Intensive Cardiovascular Care Unit (ICVCU) RSUD Dr Moewardi Surakarta secara berurutan dilibatkan sebagai subjek penelitian kemudian secara acak dibagi dalam dua kelompok yaitu kelompok perlakuan yang mendapat atorvastatin 80 mg sebelum fibrinolisis sebanyak 15 pasien dan kelompok kontrol yang tidak mendapat atorvastatin 80 mg sebelum fibrinolisis sebanyak 15 pasien. Serum darah diambil sebelum dan 24 jam setelah tindakan fibrinolisis pada semua pasien. Kadar NO diperiksa secara Colorimetric. Dilakukan uji Independent t-test untuk data yang lulus uji normalitas. Dianggap bermakna secara statistik bila nilai p < 0,05.
Hasil : Peningkatan kadar NO pada kelompok perlakuan lebih tinggi dibandingkan kelompok kontrol dan bermakna secara statistik (3,18 ± 1,52 vs 1,88 ± 1,55; p = 0,028)
Kesimpulan : Pemberian atorvastatin 80 mg segera sebelum tindakan fibrinolisis meningkatkan kadar nitric oxide pada pasien infark miokard akut dengan elevasi segmen ST
Kata kunci : Atorvastatin, fibrinolisis, nitric oxide, infark miokard akut

ABSTRACT
Background : Incidence of acute myocardial infarction as a form of coronary heart disease (CHD) was increasing. Reperfusion as definitive therapy aims to relaunch the bloodstream and improve endothelial dysfunction. Previous studies have demonstrated the beneficial effect of additional therapy prior to reperfusion to improve endothelial dysfunction. Statins as lipid-lowering therapy have pleiotropic effects that have been shown to improve endothelial dysfunction. Giving statins before primary percutaneous coronary intervention shown to increase levels of nitric oxide (NO). Data on statin before fibrinolysis action was still lacking.
Aims : To determine the effect of atorvastatin 80 mg immediately prior to fibrinolysis on nitric oxide levels in patients with acute myocardial infarction.
Methods : This study was a randomized controlled trial (RCT). 30 consecutive patients with acute myocardial infarction undergoing fibrinolysis at Intensive Cardiovascular Care Unit (ICVCU) Dr Moewardi Hospital Surakarta were included in the study. The eligible patients were randomized into two groups : Treatment group (atorvastatin 80 mg prior to fibrinolysis, n=15) and Control group (without atorvastatin prior to fibrinolysis, n=15). Venous blood samples were collected from all patients prior to and 24 hours after fibrinolysis. Serum concentrations of NO were measured using colorimetric assays. Normally distributed data were compared using independent t-test. P < 0,05 was considered to indicate a statistically significant difference.
Results : Increased levels of NO in the treatment group was higher than the control group and statistically significant (3,18 ± 1,52 vs 1,88 ± 1,55; p = 0,028).
Conclusions : Administration of atorvastatin 80 mg immediately prior to fibrinolysis increases levels of nitric oxide in patients with acute myocardial infarction with ST segment elevation
Keywords : Atorvastatin, fibrinolysis, nitric oxide, acute myocardial infarction