Abciximab Attenuates Coronary Microvascular Endothelial Dysfunction After Coronary Stenting

Abstract

Background-Platelet glycoprotein IIb/IIIa receptor blockade with abciximab decreases ischemic events after percutaneous coronary intervention (PCI); however, the mechanism of this benefit has not been fully elucidated. The present study was designed to assess endothelium-dependent vasomotion after coronary stenting and to determine if abciximab alters this response. Methods and Results-The study group consisted of 48 patients (59Ϯ10 years of age) with discrete coronary stenoses who underwent stenting alone (nϭ28) or stenting plus abciximab (nϭ20). A control group consisted of 31 additional patients who had vasomotor testing on a non-PCI vessel. Coronary blood flow (CBF) was measured (0.014-inch Doppler wire) 30 minutes after uncomplicated PCI and in response to the intracoronary infusion of acetylcholine (Ach) (10 Ϫ7 , 10 Ϫ6 mol/L Ach) and adenosine (24 g). Ach-mediated increase in CBF was impaired after stent insertion when compared with the control group (41Ϯ52% versus 70Ϯ48%; PϽ0.05). The stenting plus abciximab group demonstrated a superior CBF response to Ach compared with the stenting alone group (83Ϯ93% versus 41Ϯ52%; PϽ0.05), with no difference between groups in the peak flow or percent change in flow to adenosine. By multivariate analysis, concomitant administration of abciximab was strongly predictive of the change in CBF to Ach (PϽ0.005). Conclusions-Abciximab preserves the CBF response to Ach after coronary stenting. The preservation of microvascular endothelial function may help explain the beneficial clinical effect of this agent in patients undergoing PCI.

Platelet Glycoprotein IIb/IIIa Receptor Blockade Improves Vascular Nitric Oxide Bioavailability in Patients With Coronary Artery Disease

“…This concept is further supported by a recent study showing that glycoprotein IIb/IIIa blockade could selectively attenuate microvascular endothelial dysfunction after coronary stenting. 10 Of note, the improved ACh response in the present study is mainly attributable to increased bioactivity of NO, because the L-NMMA effect was markedly improved during glycoprotein IIb/IIIa blockade. This beneficial effect was not evident when treatment with tirofiban was stopped for a period of 6 hours, clearly indicating that improvement of endothelial function was secondary to platelet inhibition.…”

“…8,9 Endothelial dysfunction and impaired NO activity, as it occurs in the presence of atherosclerosis and its risk factors, may predispose to abnormal plateletendothelial interaction with unopposed platelet activation and increased susceptibility to vasoconstriction. Notably, in the setting of endothelial dysfunction and platelet activation owing to septic shock 7 and coronary stenting, 10 glycoprotein IIb/IIIa receptor blockade has recently been shown to have beneficial effects on endothelium-dependent vasodilation. It remains to be established whether or not glycoprotein IIb/IIIa receptor blockade is able to improve endothelial dysfunction in patients with coronary artery disease.…”

Arterial stiffness or endothelial dysfunction as a surrogate marker of vascular risk

“…The subject of pharmacological treatment of endothelial dysfunction has been reviewed by myself and others recently (52,94,95). Suffice it to say, interventions associated with favourable cardiovascular outcomes have been associated with attenuation of endothelial dysfunction for the most part (96)(97)(98)(99)(100)(101). The notable exception to this is hormone replacement therapy, which has been associated with improvement in endothelium-dependent vasomotion, but not cardiovascular outcome.…”

Intracoronary Abciximab Use in Patients Undergoing PCI at a Community Hospital: A Single Operator Experience

“…Thus, the highest concentrations of IC abciximab are achieved in the culprit vessel providing optimal clot lysis. It would also help prevent further clot aggregation and maintain the stability of the microvasculature poststenting, 14 after a procedure that is definitely traumatic. It would avoid clot dissolution at the groin entry site and theoretically prevent major bleeding locally.…”