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"Latar belakang: micro-RNA saat ini telah diketahui berperan dalam patofisiologi berbagai penyakit termasuk di bidang kardiovaskular. miR-26a platelet dikaitkan dengan aktifitas platelet tinggi.Resistensi klopidogrel telah diketahui memiliki prevalensi yang cukup tinggi di populasi Asia, yang mana dapat mempengaruhi mortalitas serta kejadian kardiovaskular mayor. Hubungan antara ekspresi miR-26a platelet dengan resistensi klopidogrel begitu pula dengan TIMI flow pasca IKPP pada IMA-EST di populasi Asia, belum pernah dilaporkan. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi miR-26a platelet terhadap reaktivitas platelet dan perfusi miokardium pasca IKPP. Metode: Pada pasien IMA-EST yang menjalani IKPP dan mendapatkan terapi dosis loadingklopidogrel 600 mg, dimasukkan kedalam populasi penelitian. Kami mengukur reaktivitas platelet dengan menggunakan VerifyNow P2Y12, aktifitas platelet tinggi didefiniskan jika memiliki nilai > 208 PRU. Metode RealtimePCR Taqman dilakukan untuk analisa ekspresi miR-26a platelet. Ekspresi miR-26a platelet dan reaktivitas platelet dikorelasikan dengan TIMI flowpasca IKPP pada pasien IMA-EST. Hasil: Terdapat 100 subyek yang direkrut pada studi ini. Diantaranya, 59% menunjukkan peningkatan ekspresi miR-26a. Reaktifitas platelet meningkat pada 27 % pasien studi ini dikategorikan non-responder terhadap klopidogrel. Terdapat hubungan antara ekspresi dengan penurunan fungsi penghambatan platelet (OR 4.2, p = 0.006). Indeks reaktivitas platelet >208 PRU meningkatkan risiko TIMI flow < 3 (OR 3.3, p= 0.015). Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIMI flow < 3. Kesimpulan: Pasien dengan peningkatan ekspresi miR-26a platelet memiliki risiko untuk mengalami menjadi non-responderklopidogrel. Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIM flowpasca IKPP.

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Background: micro-RNA has now been known to play a role in the pathophysiology of various diseases including cardiovascular disease. Clopidogrel resistance has been known prevalent in Asian population, that may affect mortality and major cardiovascular events. The relationship between the expression of platelet miR-26a and clopidogrel resistance as well as TIMI flow post primary PCI in STEMI among Asian populations, has never been done.

Objective: the aim of this study is to define whether miR-26a platelet expression has a relation with platelet reactivity and myocardial perfusion after primary PCI.

Methods: STEMI patients who underwent primary PCI and has received 600 mg loading dose of clopidogrel were recruited for the study. We measured platelet reactivity by VerifyNow P2Y12, high platelet reactivity was defined as > 208 PRU. Realtime PCR by taqman method were performed to asses the expression of miR-26a platelet. miRNA-26a platelet expression and platelet reactivity were correlated with TIMI flow post primary PCI in STEMI.

Hasil: there were 100 patients recruited for this study. among them, 59% of patients with high expression of miR-26a platelet. Platelet reactivity showed 27% of the patients were clopidogrel non-responders. There was a relationship between high miR-26a expression and decreased function of platelet inhibition (OR 4.2, p = 0.006). Platelet reactivity index > 208 increased the risk of suboptimal reperfusion (OR 3.3, p = 0.015). There was no direct correlation between miR-26a expression and TIMI flow < 3.

Conclusion: Patients with high miR-26a platelet expression had increased risk of being clopidogrel non responders. There is no direct relationship between miR-26a platelet expression and TIMI flow after primary PCI."

"Implantasi stent koroner yang tidak adekuat berhubungan dengan terjadinya major adverse cardiac event (MACE). Prosedur post dilatasi pasca implantasi stent terbukti memberikan ekspansi stent yang optimal. Namun, studi mengenai aplikasi strategi ini dalam intervensi koroner perkutan primer (IKPP) masih terbatas. Penelitian ini bertujuan mengetahui luaran klinis dari post dilatasi pasca implantasi stent pada pasien infark miokard akut elevasi segmen ST (IMA-EST) yang menjalani IKPP dalam kurun waktu satu tahun. Penelitian ini merupakan studi kohort retrospektif. Luaran klinis primer berupa MACE yang terdiri dari kejadian infark miokard berulang, total repeat revascularization, kematian kardiovaskular dan kematian semua sebab. Luaran klinis sekunder berupa trombosis stent. Total 288 pasien yang dianalisis (130 kelompok post dilatasi dan 158 kelompok tanpa post dilatasi). Tanpa post dilatasi memiliki perbedaan bermakna dengan angka kejadian MACE yang lebih tinggi (adjusted OR 1,82 (95% IK 1,003 – 3,32, p 0,049), kematian kardiovaskular, (adjusted OR 5,29 (95% IK 1,4 – 19,2, p 0,012) dan kematian semua sebab (adjusted OR 4,05 (95% IK 1,45 – 11,3, p 0,007) dalam waktu satu tahun. Proporsi juga meningkat untuk kejadian infark miokard berulang (6,9% vs 11,4%; p 0,19) walaupun tidak bermakna secara statistik. Post dilatasi pasca implantasi stent menunjukkan luaran klinis yang lebih baik pada tindakan IKPP.

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Inadequate coronary stent implantation is associated with a major adverse cardiac event (MACE). Post-dilation procedure after stent implantation has been shown to provide optimal stent expansion. However, studies regarding this application in primary percutaneous coronary intervention (PPCI) are still limited. This study aims to investigate clinical outcomes of post-dilatation after stent implantation in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI within one year. This study is a retrospective cohort study. Primary clinical outcome is MACE which consists of recurrent myocardial infarction, total repeat revascularization, cardiovascular death and all causes of death. Secondary clinical outcome is stent thrombosis. A total of 288 patients were analyzed (130 post-dilatation groups and 158 without post-dilatation groups). Without post-dilatation, there was a significant difference with a higher incidence of MACE (adjusted OR 1.82 (95% CI 1.003 - 3.32, p 0.049), cardiovascular death, (adjusted OR 5.29 (95% IK 1.4 - 19.2, p 0.012) and all-cause mortality (adjusted OR 4.05 (95% CI 1.45 - 11.3, p 0.007) within one year. Proportion also increased for the incidence of recurrent myocardial infarction (6.9 % vs 11.4%; p 0.19) although not statistically significant. Post-dilatation procedures after stent implantation showed better clinical outcomes in patients undergoing PPCI."