Hadipurnomo et al., 2015 8 Correlation of Serum Levels of Matrix Metalloproteinase-9 to Acute Heart Failure Event as a Complication af Acute Coronary Syndrome Sasongko Hadipurnomo 1 , Budi Yuli Setianto 1,2 , Lucia Kris Dinarti 1,2 1 Departement of Internal Medicine, Medical Faculty of Universitas Gadjah Mada / Sardjito General Hospital Yogyakarta 2 Departemen of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada / Sardjito General Hospital Yogyakarta Abstract Background: Acute heart failure (AHF) after acute coronary syndrome (ACS) is the biggest complication with a poor prognosis in a long term. The influence of MMP-9 as proteolytic enzyme that degrades extracellular matrix in remodeling left ventricle was recognized. However, according to researcher’s knowledge, evaluation of the MMP-9 as a predictor of AHF after ACS was never reported. Objective: To find out the serum level of MMP-9 in ACS with AHF higher than that without it, as well as to find out the level of MMP-9 with risk of AHF after ACS. Method: The study used a cross-sectional study. Samples were collected by using a consecutive sampling technique among patients with ACS treated in ICCU of Public Hospital Dr Sardjito Yogyakarta, since June 2008 to August 2010. Questionnaires were used to collect sample raw data. The level of MMP-9 was examined a time at admission in ICCU before trombolysis was done. The heart failure had Killip II- IV scores. Factors influencing the incidence was analyzed by using multivariate analysis technique. A significance level was at p< 0.05. The relative risk of acute heart failure at a certain level of MMP-9 (from cut-off value) was obtained after it was adjusted. Result: Among 122 subjects, 75 was without AHF and 47 with AHF. Median of the level of MMP-9 in the whole sample of ACS was 1248.55 ng/mL with a minimum of 170.50 ng/mL and maximum of 3058.40 ng/mL. Moreover, the level of MMP-9 in ACS with AHF (1700.81±740.43 ng/mL) was significantly higher than ACS without AHF (1189.55±654.60 ng/mL) with p value = 0.000. Independent risk factor after the multivariate analysis was done indicates the level of MMP-9 above 1444 ng/mL (RR= 4.2) and the location of anterior infarction (RR= 2.9). Conclusion: In patients with ACS treated in ICCU of RSUP Dr Sardjito, the level of MMP-9 with AHF was higher than that without it. If the level of MMP-9 above 1444 ng/mL, the possibility of AHF was 4.2 times. Keywords: ACS, MMP-9, AHF after ACS Introduction Kyne et al. (2000) stated that heart failure is the biggest complication of ACS and a clinical problem with a poor prognosis in the long run about 50% to 70% among elderly patients 1 . Acute heart failure is associated with post-AMI mortality rates as expressed in ESC (2005) in a large randomized control trial study on patients hospitalized with decompensated heart failure, 60-days mortality of 9.6%, combined death and 60-days rehospitalization of 35%. The largest of death in acute heart failure was due to IMA of 30% in 12 months 2 . Remodeling as a concept that underlies the occurrence of heart failure has widely been studied, one of which was associated with the involvement of matrix metalloproteinase (MMP), especially after the ACS. There are 25 types of MMP and MMP-9 with gelatinase activity, which has wide influence on ventricular remodeling and heart failure (Armstrong, 2006 and Phatharajaree et al., 2007) 3,4 . According to Jong et al. (2006) the levels and activities of MMP-9 increased in patients with post-AMI acute heart failure, while those of MMP-2 did not show any difference 5 . The purposes of this study are to find out difference in serum levels of MMP9 at ACS between with and without acute heart failure, and to examine the effect of increase in serum levels of MMP-9 at ACS on acute heart failure. METHOD The cross sectional study was conducted at the Intensive Cardiac Care Unit (ICCU) of Public Hospital Dr. Sardjito Yogyakarta from June 2008 to August 2010. The subjects of the study were recruited consecutively until the required number of samples was reached. Anamnesis, physical