title: The relation of renal function to ischemic and bleeding outcomes with 2 different glycoprotein IIb/IIIa inhibitors: the do Tirofiban and ReoPro Give Similar Efficacy Outcome (TARGET) trial.
abstract: BACKGROUND
  Renal function significantly impacts morbidity and mortality after a percutaneous coronary intervention. Platelet glycoprotein (GP) IIb/IIIa inhibitors reduce ischemic complications during percutaneous coronary intervention; little is known of whether their safety and efficacy are influenced by renal function. In particular, whether outcome differences exist between agents that are renally excreted (tirofiban) or not (abciximab) in patients with mild renal impairment is not known.
  
  
  METHODS
  The TARGET trial randomized 4623 patients to tirofiban or abciximab. In this analysis, patients were grouped in creatinine clearance quartiles (<70, 70-90, 90-114, >114 mL/min) and analyzed for efficacy and bleeding risk. Univariate and multivariate analyses were performed to identify interactions between GP IIb/IIIa inhibitor used and creatinine clearance with respect to ischemic outcomes and bleeding.
  
  
  RESULTS
  Using unadjusted logistic regression tests for trend, 30-day death/myocardial infarction/urgent target vessel revascularization was greater in patients with lower creatinine clearances (7.3%, 8.5%, 5.1%, and 5.8%, P = .005), as were both major and minor bleeding. There was no interaction between assigned GP IIb/IIIa inhibitor, creatinine clearance and ischemic outcome, major bleeding or minor bleeding.
  
  
  CONCLUSIONS
  Both ischemic and bleeding complications are highest in the lowest creatinine clearance quartile of patients treated with GP IIb/IIIa inhibitors. Although tirofiban is renally cleared and abciximab is not, there was no interaction between these GP IIb/IIIa inhibitors and creatinine clearance regarding ischemic or bleeding events.
authors.affiliation: Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn 55905, USA. berger.peter@mayo.edu
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Patricia J M
authors.initials: PJ
authors.lastname: Best
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Jennifer
authors.initials: J
authors.lastname: White
authors.forename: Peter M
authors.initials: PM
authors.lastname: DiBattiste
authors.forename: Albert W
authors.initials: AW
authors.lastname: Chan
authors.forename: Steen D
authors.initials: SD
authors.lastname: Kristensen
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: David J
authors.initials: DJ
authors.lastname: Moliterno
mesh_terms: D000077284:Abciximab; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000493:pharmacokinetics / Q000627:therapeutic use*; D023921:Coronary Stenosis / Q000628:therapy; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D051437:Renal Insufficiency / Q000150:complications* / Q000378:metabolism; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D003404:Creatinine; D000077466:Tirofiban; D000077284:Abciximab