Triple antiplatelet therapy during percutaneous coronary intervention is associated withimproved outcomes including one-year survival: Results from the do tirofiban and reoprogive similar efficacy outcome trial (TARGET)

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Abstract

Objectives

We sought to examine if clopidogrel treatment initiated before coronary stenting improved clinical outcomes among patients receiving aspirin and a glycoprotein (GP) IIb/IIIa inhibitor.

Background

Antiplatelet therapy plays a pivotal role in contemporary percutaneous coronary interventions (PCI).

Methods

Outcomes among 4,809 patients randomized to tirofiban or abciximab during PCI with stent placement were compared according to whether they received 300 mg of clopidogrel before PCI (93.1%) versus immediately after the procedure.

Results

The 30-day primary composite end point (death, myocardial infarction [MI], or urgent target vessel revascularization [TVR]) was lower among clopidogrel-pretreated patients (6.6% vs. 10.4%, p = 0.009), mainly because of reduction of MI (6.0% vs. 9.5%, p = 0.012). The benefit of clopidogrel pretreatment was sustained at six months (death, MI, any TVR: 14.6% vs. 19.8%, HR = 0.71, p = 0.010), and this was due mainly to lowering of death and MI (7.8% vs. 13.0%, p = 0.001). At one year, clopidogrel pretreatment was associated with a lower mortality rate (1.7% vs. 3.6%, p = 0.011). Because clopidogrel pretreatment was not randomized, multivariable and propensity analyses were performed. After adjusting for baseline heterogeneity, clopidogrel pretreatment was an independent predictor for death or MI at 30 days (HR = 0.63, p = 0.012) and at six months (HR = 0.61, p = 0.003), and survival at one year (HR = 0.53, p = 0.044). No excess in 30-day bleeding events was noted with clopidogrel pretreatment.

Conclusions

Among patients undergoing coronary stent placement with aspirin and a GP IIb/IIIa inhibitor, clopidogrel pretreatment is associated with a reduction of death and MI irrespective of the type of GP IIb/IIIa inhibitor used.

Abbreviations

ACS
acute coronary syndrome
ADP
adenosine diphosphate
CREDO
Clopidogrel for Reduction of Events During Observation
EPISTENT
Evaluation of Platelet IIb/IIIa Inhibitor for Stenting
GOLD
Assessing Ultegra-AU Study
GP
glycoprotein
MI
myocardial infarction
PCI
percutaneous coronary intervention
PCI-CURE
PCI substudy of the Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial
TIMI
Thrombolysis In Myocardial Infarction
TVR
target vessel revascularization

Cited by (0)

The TARGET study was supported by Merck, Inc., West Point, Pennsylvania. Dr. DiBattiste is an employee of Merck.

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For the full list of TARGET investigators, please refer to N Engl J Med 2001;344:1888–94