Abstract 3804: Safety and Effectiveness of Bivalirudin in Non ST-Segment Elevation Acute Coronary Syndromes by Duration of Upstream Infusion in the ACUITY Trial: Implications for Emergency Department and Upstream Management
Objectives: In ACUITY, bivalirudin monotherapy (Biv mono) resulted in superior net clinical outcomes compared to heparin (unfractionated or enoxaparin) plus a glycoprotein inhibitor(H+PI) in pts with moderate and high risk NSTE ACS managed with an early invasive strategy.Contemporary US registry data show that NSTE ACS pts are typically managed medically for 20 or more hours prior to revascularization and may have ongoing and recurrent ischemia during this time. We sought to evaluate the impact of time to angiography or intervention as well as treatment strategy on patient outcomes.
Methods: We compared the 30d rates of composite ischemia, major bleeding and net clinical outcomes (ischemia + bleeding) in patients undergoing angiography or intervention ≤24h versus >24h from randomization as a function of randomized treatment.
Results: Of 13,819 pts enrolled, 11,178 (80.9%) underwent angiography or intervention within 24h of randomization. Patients receiving angiography/ intervention >24h from randomization had significantly higher 30d rates of composite ischemia (8.9% vs. 7.3%, p=0.006), major bleeding (6.2% vs. 4.3%, p<0.001), and net clinical outcomes (13.8% vs. 10.6%, p<0.001). Findings were confirmed by regression analysis. Results appear in Table⇓.
Conclusions: A delay in angiography or intervention of >24h is associated with increased ischemia and bleeding compared to more rapid therapy in NSTE ACS. Compared with H+GPI, Biv mono significantly reduces major bleeding regardless of time to angiography or intervention and improves net clinical outcomes in patients with delays to treatment.