The effects of tirofiban on peripheral markers of oxidative stress and endothelial dysfunction in patients with acute coronary syndromes

Background: Endothelial dysfunction and oxidative stress are believed to be central mechanisms in atherogenesis. We aimed to determine the effects of tirofiban on oxidative stress and neutrophil-endothelium interaction markers in patients with acute coronary syndromes (ACS). Materials and methods: We measured malondialdehyde (MDA), interteukin-6 (IL-6) and soluble endothelial intercellular and vascular adhesion molecules (sICAM-1 and sVCAM-1) on admission, at 48 and 72h and on 5th day of hospitalization in 34 patients (age 66.5 +/- 1.8 years) with ACS. Patients with recurrent angina, changes on the electrocardiogram and/or elevated troponin I received intravenously tirofiban for 48h and the others received normal saline. Results: Baseline concentrations of all markers did not differ significantly and compared with placebo, tirofiban infusion markedly reduced MDA, IL-6, sICAM-1 and sVCAM-1 at 48h (-31 +/- 6% vs. 84 +/- 49%, p = 0.007, -12 +/- 14% vs. 23 +/- 10%, p = 0.05, -20 +/- 6% vs. 36 +/- 25%, p = 0.04 and -10 +/- 5% vs. 6 +/- 5%, p = 0.02, respectively). Relative to baseline, significant reductions were observed for all 4 markers at 72h and day 5 (p < 0.05). Conclusion: Tirofiban potentiates the decline in oxidative stress and may reverse abnormal endothelial activation in patients with ACS. This benefit seems to remain over the following 5 days. (c) 2006 Elsevier Ltd. All rights reserved.