Optimization of glycoprotein IIb/IIIa blockade during percutaneous coronary interventions: Insights from TARGET after 1 year

Tirofiban and abciximab are two intravenous platelet glycoprotein IIb/IIIa antagonists that are commonly used in percutaneous coronary interventions. They differ in their integrin specificities, therapeutic half-lives, and costs. The Do Tirofiban and ReoPro Give Similar Efficacy Outcome Trial (TARGET) was the first direct comparative trial of these two agents, and assessed the 30-day composite of death, myocardial infarction, and urgent target-vessel revascularization as the primary end point. The overall result showed that tirofiban was associated with a 26% worse outcome than abciximab. Considering subgroups, among patients presenting with an acute coronary syndrome, abciximab was superior to tirofiban, but the two agents had similar efficacy among nonacute coronary syndrome patients. With among the largest number of diabetic patients enrolled in a randomized percutaneous coronary intervention trial, this study showed no significant difference in efficacy of the two agents among diabetic patients, suggesting the lack of a meaningful role of vitronectin or Mac-1 inhibition by abciximab in improving late survival or restenosis after percutaneous coronary intervention in diabetics. Lastly, the improved composite events associated with clopidogrel in pretreated patients provide support for the routine practice of dual antiplatelet protection prior to intervention.