Abstract 5610: Bivalirudin in Patients with Acute Coronary Syndromes Undergoing Saphenous Vein Graft Percutaneous Coronary Intervention: A Subgroup Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) Trial
Background: There is limited data on the outcomes of patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) according to anticoagulation regimen. We therefore examined the clinical outcomes among patients randomized in the large-scale prospective, randomized ACUITY trial who underwent PCI of a SVG.
Methods: The ACUITY trial was a multicenter, randomized trial assessing the safety and efficacy of bivalirudin alone or bivalirudin plus glycoprotein IIb/IIIa inhibitor (GPI) vs. heparin plus GPI among 13,819 patients with moderate and high-risk acute coronary syndromes (ACS), 7,789 of whom underwent PCI. The primary endpoints at 30 days were composite ischemia (death, MI, or unplanned TVR for ischemia), major bleeding (non CABG), and net adverse clinical events (NACE=composite ischemia or major bleeding).
Results: A total of 329 patients underwent PCI of a SVG in ACUITY. Of these 114 were randomized to bivalirudin alone, 114 to bivalirudin plus GPI, and 101 to heparin plus GPI. Drug-eluting stents were used in 77% of pts. The 3 groups were well balanced for age, gender, diabetes, hypertension, current smoking, prior MI, TIMI risk score, aspirin and clopidogrel use, and DES use. 30-day and 1-year outcomes in the SVG cohort according to randomization arm are shown in the Figure⇓.
Conclusions: In this subgroup analysis from the randomized ACUITY trial, the rates of composite ischemia, major bleeding and NACE after PCI of a SVG in ACS were comparable in pts treated with either bivalirudin alone or bivalirudin plus a GPI compared to heparin plus a GPI.