A Comparison of Tirofiban and Abciximab in Patients Undergoing Coronary Stent Implantation: Rationale, Design, and Results of the TARGET Trial.
Three intravenous glycoprotein IIb/IIIa inhibitors, abciximab, tirofiban, and eptifibatide, when administered intravenously just before percutaneous intervention, have been shown to reduce the composite 30-day occurrence of death, myocardial infarction, or urgent target vessel revascularization. These agents differ from each other notably in chemical structure, pharmacokinetics, and pharmacodynamic activity. Whether they are clinically equivalent can be answered only by a well-designed, large scale, head-to-head randomized trial. The TARGET trial prospectively compared the efficacy of abciximab with that of tirofiban as an adjunct to coronary stent implantation in 4809 randomized patients with diverse characteristics. The 30-day results demonstrated that abciximab offered greater protection than tirofiban from major ischemic events, principally due to a significant reduction in peri-procedural myocardial infarction, with the greatest effect seen in patients with acute coronary syndromes. However, by 6 months the differences between the two agents had largely disappeared such that the composite rates of death, myocardial infarction, and target vessel revascularization were similar. The implications of this study on the cost-effective utilization of glycoprotein IIb/IIIa inhibitors are profound.
El-Omar
Magdi M.
MM
The Cardiovascular Research Foundation, and Lenox Hill Heart and Vascular Institute, 55 East 59th Street, 6th Floor, New York, NY 10022, USA. gstone@crf.org
Dangas
George
G
Stone
Gregg W.
GW