Peran Duke Treadmill Score sebagai Prediktor Penyakit Jantung Koroner pada Pasien dengan Uji Treadmill Positif The Role of Duke Treadmill Score as a Predictor of Coronary Artery Disease in Patients with Positive Treadmill Test Results

Pendahuluan. Coronary Artery Disease (CAD) merupakan penyakit yang masih menjadi penyebab utama morbiditas dan mortalitas di dunia. Uji treadmill merupakan modalitas diagnostik untuk CAD yang tersedia secara luas di Indonesia, namun performa ketepatan diagnostiknya masih perlu ditingkatkan. Penelitian yang dilakukan ini menggunakan Duke Treadmill Score (DTS) sebagai prediktor Coronary Artery Disease. Metode. Penelitian ini menggunakan desain studi potong lintang yang dilakukan pada subjek dengan CAD stabil berusia 18-75 tahun yang menjalani uji treadmill dengan hasil positive ischemic response dan sudah dilakukan korangiografi di Poliklinik Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo (RSCM) dalam kurun waktu Januari 2011 hingga Desember 2013. Hasil. Didapatkan 103 subjek dengan 37,9% diagnosis CAD signifikan dari corangiografi. Dari ROC (Receiver Operator Curve) ditentukan titik potong DTS pada nilai -8,85. Didapatkan nilai sensitivitas, spesifisitas, nilai duga positif (NDP) dan nilai duga negatif (NDN) DTS masing-masing sebesar 28% (IK 95%: 17%-44%), 95% (IK 95%: 87%-98%), 79% (IK 95%: 52%-92%) dan 69% (IK 95%: 58%-77%). Simpulan. Disimpulkan DTS dapat memprediksi CAD yang signifikan pada titik potong -8,85 untuk pasien uji treadmill positif dengan nilai duga positif yang cukup baik. Kata Kunci: CAD, DTS, uji treadmill The Role of Duke Treadmill Score as a Predictor of Coronary Artery Disease in Patients with Positive Treadmill Test Results Introduction. Coronary Artery Disease (CAD) is one of the disease entity that leading cause of morbidity and mortality in worldwide. Treadmill test is part of the diagnostic modality which readily available to assess possibility of narrowing coronary artery and guiding us whether we need for the further investigation. Despite of that, treadmill test has limitation in diagnostic accuracy. Duke Treadmill Score (DTS) was also tested as a diagnostic score, and shown to predict significant CAD better than the ST-segment response alone. Methods. This is a cross-sectional study performed in adult patients with stable CAD that underwent treadmill test and coronary angiography in outward patient clinic of the Integrated Cardiac Service in Cipto Mangunkusumo Hospital between January 2011 and December 2013. Results. A total of 103 patients in this study, thirty nine patients (37,9 %) had significant CAD in coronary angiography. Briefly, mean age was 54,71 years and 55 patients (53,4 %) were females. The most common CAD risk factor was hypertension (51,5 %). A mean of DTS score was -3.53, which mostly categorized as intermediate risk (89,3 %). Based on DTS results, cut-off point was determined by using Receiver Operator Curve (ROC) method, in which value of -8,85 considering as a cut-off point. Sensitivity and specificity value of DTS were 28 % (CI 95 %: 17 % to 44 %), and 95 % (CI 95 %: 87 % to 98 %). Positive and negative predictive value were 79 % (CI 95 %: 52 % to 92 %) and 69 % (CI 95 %: 58 % to 77 %). Positive and negative likelihood ratio were 6.02 and 0.75. Conclusions . DTS has a good performance in predicting significant CAD at cut-off point -8,85 in patients with positive treadmill test. Keywords: CAD, DTS, treadmill test