Low miR-19b-1-5p Expression Is Related to Aspirin Resistance and Major Adverse Cardio- Cerebrovascular Events in Patients With Acute Coronary Syndrome.

Background Because of a nonresponse to aspirin (aspirin resistance), patients with acute coronary syndrome (ACS) are at increased risk of developing recurrent event. The in vitro platelet function tests have potential limitations, making them unsuitable for the detection of aspirin resistance. We investigated whether miR-19b-1-5p could be utilized as a biomarker for aspirin resistance and future major adverse cardio-cerebrovascular (MACCE) events in patients with ACS. Methods and Results In this cohort study, patients with ACS were enrolled from multiple tertiary hospitals in Christchurch, Hong Kong, Sarawak, and Singapore between 2011 and 2015. MiR-19b-1-5p expression was measured from buffy coat of patients with ACS (n=945) by reverse transcription quantitative polymerase chain reaction. Platelet function was determined by Multiplate aggregometry testing. MACCE was collected over a mean follow-up time of 1.01±0.43 years. Low miR-19b-1-5p expression was found to be related to aspirin resistance as could be observed from sustained platelet aggregation in the presence of aspirin (-Log-miR-19b-1-5p, [unstandardized beta, 44.50; 95% CI, 2.20-86.80; P<0.05]), even after adjusting for age, sex, ethnicity, and prior history of stroke. Lower miR-19b-1-5p expression was independently associated with a higher risk of MACCE (-Log-miR-19b-1-5p, [hazard ratio, 1.85; 95% CI, 1.23-2.80; P<0.05]). Furthermore, a significant interaction was noted between the inverse miR-19b-1-5p expression and family history of premature coronary artery disease (P=0.01) on the risk of MACCE. Conclusions Lower miR-19b-1-5p expression was found to be associated with sustained platelet aggregation on aspirin, and a higher risk of MACCE in patients with ACS. Therefore, miR-19b-1-5p could be a suitable marker for aspirin resistance and might predict recurrence of MACCE in patients with ACS.

When one complication begets another - A case report of radial artery pseudoaneurysm following radial artery occlusion post-transradial coronary angiography.

The transradial approach for coronary angiography and intervention is the preferred approach because of its superior safety profile as compared to the transfemoral approach. However, like all procedures, transradial approach is not free from complications. In this case, we describe a unique case of a large symptomatic radial artery pseudoaneurysm requiring urgent surgical intervention. The pseudoaneurysm developed after treatment with a short duration of subcutaneous low molecular weight heparin for radial artery occlusion that occurred a day after transradial coronary catheterization. The pseudoaneurysm was repaired successfully and there was no recurrence during subsequent follow-up. Access-related complications post transradial approach are generally uncommon and this is the first reported case of radial artery occlusion further complicated by a large pseudoaneurysm to the best of our knowledge. Preventive measures are crucial in reducing radial artery occlusion while we recommend an individualized approach based on clinical history coupled with anatomic features of pseudoaneurysm in managing radial artery pseudoaneurysm. 〈Learning objective: Access-related complications post transradial approach coronary angiography, while rare, can still occur. Preventive measures as well as close monitoring post angiography are crucial in the prevention as well as early detection of access-related complications. Management of radial artery pseudoaneurysm should be individualized based on clinical context as well as anatomic characteristics of the pseudoaneurysm.〉.