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Abciximab More Effective than Tirofiban in Treating Some Acute Coronary Syndrome Patients
March 21, 2002

ATLANTA, Georgia (ACC) -- In patients undergoing stent procedures, glycoprotein IIb/IIIa inhibitors have been shown to reduce the risk of immediate complications and improve patient outcomes. However, not yet established is the relative safety and efficacy of different IIb/IIIa agents and whether the acuity of the presenting clinical syndrome, which may affect the degree of platelet inhibition required or achieved, influences the response to different anti-platelet agents.

The Do Tirofiban and ReoPro Give Similar Efficacy Trial, or TARGET, may shed some light on this issue. In the trial, patients who needed stenting as a result of an acute coronary syndrome (ACS) were significantly less likely to experience a heart attack within 30 days and six months if they were treated initially with abciximab vs. tirofiban.

The trial randomized 4,809 patients undergoing PCI with stenting to either abciximab or tirofiban. Of these, 3,025 had ACS and 1,784 were non-ACS patients. In particular, said TARGET lead researcher Gregg W. Stone, MD, of the Lenox Hill Heart and Vascular Institute, New York, abciximab proved to be more effective than tirofiban in reducing the combined endpoint of death, myocardial infarction (MI), and urgent target vessel revascularization (TVR) 30 days after stenting. The 30-day composite incidence of death, MI, or urgent TVR in ACS patients occurred in 6.3 percent of patients given abciximab vs. 9.3 percent given tirofiban. Those percentages were 5.6 and 4.5 percent, respectively, in non-ACS patients. Dr. Stone presented his findings at a press conference Sunday.

By six months, 15.1 percent of ACS patients on abciximab vs. 17.6 percent of ACS patients on tirofiban experienced death, MI, or any TVR. For non-ACS patients, the percentages were 13 percent and 10.2 percent, respectively. The TARGET trial, published last November in The New England Journal of Medicine, showed no apparent difference in mortality with either inhibitor at 30 days, six months, or one year.

In terms of specific events, ACS patients treated with abciximab undergoing stent implantation had lower 30-day (5.8 percent vs. 8.5 percent, respectively) and six-month (7.1 percent vs. 9.6 percent, respectively) rates of MI than ACS patients with tirofiban. However, survival was identical, said Dr. Stone. For ACS patients, 0.5 percent on abciximab and 1.1 percent on tirofiban experienced urgent TVR vs. 0.9 percent and 0.5 percent of non-ACS patients, respectively.

For Dr. Stone, the potency of these IIb/IIIa inhibitors have far-reaching implications. “These data raise important issues regarding the relative pharmacocdynamic potency of IIb/IIIa inhibition required in varying clinical scenarios,” he said, “as well as having important implications for cost-effective utilization of IIb/IIIa inhibitors.”

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