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Angiographic Findings in Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) Trial

Angiographic Findings in Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) Trial. Alexandra J. Lansky 1 , Ken Mori 1 , Ricardo A. Costa 1 , Michel Bertrand 2 , Frederick Feit 3 , Cordy Pietras 1 , Ecatarina Cristea 1 , Stuart Pocock 4 , Magnus Ohman 5 , Gregg W. Stone 1.

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Angiographic Findings in Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) Trial

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  1. Angiographic Findings in Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) Trial Alexandra J. Lansky1, Ken Mori1, Ricardo A. Costa1, Michel Bertrand2, Frederick Feit3, Cordy Pietras1, Ecatarina Cristea1, Stuart Pocock4, Magnus Ohman5, Gregg W. Stone1 1. Cardiovascular Research Foundation, New York, NY; 2. Hospital Cardiologique, Lambersart, France 3. New York University Medical Center, NY 4. London School of Hygiene and Tropical Medicine, London, United Kingdom 5. University of North Carolina, Chapel Hill, NC

  2. Background • A number of angiographic morphologic parameters of prognostic importance have been identified in ACS pts undergoing PCI including the extent of disease, the presence of thrombus and coronary flow characteristics. • ACUITY Angiographic substudy was designed to investigate the angiographic findings in a cohort of patients enrolled in US.

  3. Medical management UFH or Enoxaparin + GP IIb/IIIa PCI Bivalirudin + GP IIb/IIIa Angiography within 72h R* Bivalirudin Alone CABG ACUITY Trial Design • Moderate-high risk unstable angina or NSTEMI undergoing an invasive strategy (N = 13,800) Moderate- high risk ACS Aspirin in all Clopidogrel dosing and timing per local practice *Stratified by pre-angiography thienopyridine use or administration ACUITY Design. Stone GW et al. AHJ 2004;148:764–75

  4. Major entry criteria • Moderate-high risk unstable angina or NSTEMI

  5. PNI <0.001 PSup = 0.015 PNI = 0.011 PSup = 0.32 PNI <0.001 PSup <0.001 ACUITY Primary Results (ITT) • Heparin* + IIb/IIIa vs. Bivalirudin + IIb/IIIa vs. Bivalirudin Alone *Heparin=unfractionated or enoxaparin

  6. ACUITY: Angiographic Substudy • Objectives: Investigate the angiographic basis of observed differences in efficacy of angiographic parameters in acute coronary syndrome patients. • Methods: Angiographic films were analyzed in a blinded manner by the independent Core Laboratory: • Baseline Angiography on all patients to assess the extent of disease • Serial analysis of diseased vessels for patients undergoing PCI to determine procedural complications and final QCA results.

  7. Consort Diagram

  8. Baseline clinical characteristics *CrCL < 60ml/min as determined by the Cockcroft-Gault equation

  9. Baseline angiographic characteristics Diseased vessel is defied as %DS>30%

  10. Baseline angiographic characteristics

  11. LAD angiographic characteristics Diseased vessel is defied as %DS>30%

  12. LAD angiographic characteristics

  13. RCA angiographic characteristics Diseased vessel is defied as %DS>30%

  14. RCA angiographic characteristics

  15. LCX angiographic characteristics Diseased vessel is defied as %DS>30%

  16. LCX angiographic characteristics

  17. PCI patients characteristics

  18. Angiographic Characteristics

  19. PCI patients lesion characteristics

  20. PCI patients lesion characteristics

  21. PCI patients lesion characteristics

  22. Side branch

  23. QCA results

  24. Conclusions • The ACUITY trial demonstrated that a bivalirudin alone strategy results in a significantly improved net clinical outcome at 30 days when compared with heparin (unfractionated or enoxaparin) plus a GP IIb/IIIa inhibitor • A further analysis of the baseline angiographic characteristics demonstrated that angiographic parameters were well-balanced between the treatment groups • There were no clinically significant differences in the angiographic outcome of patients who underwent further PCI

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