TARGET versus GUSTO-IV: appropriate use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes and percutaneous coronary intervention

Until recently, the selection of which glycoprotein IIb/IIIa inhibitor to use for patients with acute coronary syndromes or those undergoing percutaneous coronary intervention largely reflected physician preference, costs, and any evidence supporting the clinical indication. Clinicians often assumed a class effect for these agents: a benefit observed for one agent in one clinical setting (such as percutaneous coronary intervention) would confer benefit in another (such as non-ST-elevation acute coronary syndromes). The need for evidence to guide treatment selection motivated the design of the Do Tirofiban and ReoPro Give Similar Efficacy Trial (TARGET) and the Global Use of Strategies to Open occluded arteries (GUSTO-IV) trials with abciximab. This review examines the results from these and other recent trials of glycoprotein IIb/IIIa inhibition in acute coronary syndromes and percutaneous coronary intervention, presents a rationale for the lack of a consistent benefit with abciximab, and describes future directions for clinical investigation.