Outcomes at 6 months for the direct comparison of tirofiban and abciximab during percutaneous coronary revascularisation with stent placement: the TARGET follow-up study

Background Two placebo-controlled trials testing intravenous platelet glycoprotein IIb/IIIa antagonists in the setting of percutaneous coronary revascularisation with intracoronary stents have shown a durable reduction in ischaemic events to 6 months. These trials differed regarding their patient population, IIb/IIIa inhibitor, and reported extent of benefit. Whether a small-molecule agent affecting only the IIb/IIIa receptor would provide a similar outcome for ischaemic events and clinical restenosis at 6 months when directly compared with a monoclonal antibody known to affect several integrin receptors is unknown. Methods In 18 countries at 149 hospitals, 4809 patients undergoing elective or urgent stent implantation were randomly assigned a bolus and infusion of tirofiban or abciximab. Patients were followed for 6 months for the occurrence of death, myocardial infarction, and any targetvessel revascularisation. The results at 30 days have been reported previously. Findings At 6 months the composite endpoint of death, myocardial infarction, and target-vessel revascularisation occurred in 356 (14•8%) patients who received tirofiban and 345 (14•3%) patients who received abciximab (hazard ratio 1•04, 95% CI 0•90–1•21, p=0•591). The rates for the individual endpoints were 191 (8•0%) versus 159 (6•6%) for myocardial infarction (hazard ratio 1•21, 95% CI 0•98–1•50; p=0•074), 26 (1•1%) versus 25 (1•0%) for death (1•04, 0•60–1•80; p=0•893), and 194 (8•1%) versus 208 (8•6%) for target-vessel revascularisation (0•93, 0•77–1•14; p=0•495). Interpretation At 6 months, tirofiban provided a similar level of overall protection to abciximab against the composite of death, myocardial infarction, and any targetvessel revascularisation.