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The ACUITY Trial randomized 13,819 patients with moderate and high-risk NSTE-ACS.

Transfusion is Associated With Increased One-Year Mortality and Ischemic Events in Patients With ACS: Results from the ACUITY Trial. Steven V. Manoukian, Michele D. Voeltz, Frederick Feit, Sunil V. Rao, Steven R. Steinhubl, George D. Dangas, Roxana Mehran, and Gregg W. Stone

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The ACUITY Trial randomized 13,819 patients with moderate and high-risk NSTE-ACS.

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  1. Transfusion is Associated With Increased One-Year Mortality and Ischemic Events in Patients With ACS: Results from the ACUITY Trial Steven V. Manoukian, Michele D. Voeltz, Frederick Feit, Sunil V. Rao, Steven R. Steinhubl, George D. Dangas, Roxana Mehran, and Gregg W. Stone Emory University School of Medicine, Atlanta, GA; New York University School of Medicine, New York, NY; Duke Clinical Research Institute, Durham, NC;University of Kentucky, Lexington, KY; Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY

  2. UFH or Enoxaparin + GP IIb/IIIa Bivalirudin + GP IIb/IIIa Angiography within 72h R* Bivalirudin Alone STUDY DESIGN • The ACUITY Trial randomized 13,819 patients with moderate and high-risk NSTE-ACS. Medical management Moderate- high risk ACS PCI Aspirin in all Clopidogrel dosing and timing per local practice CABG

  3. PNI <0.001 PSup = 0.015 PNI <0.001 PSup <0.001 PNI = 0.011 PSup = 0.32 ACUITY Primary Results – 30 Days

  4. ACUITY Primary Results – 1 Year

  5. BACKGROUND & OBJECTIVES • Blood product transfusion is an important complication in ACS patients treated with potent antithrombotic and antiplatelet agents. • Transfusion is associated with an increase in adverse outcomes in ACS, including mortality. • In ACUITY, transfusion was defined as the administration of any non-CABG related blood product, including whole blood, packed red blood cells, platelets, or fresh frozen plasma within 30 days. • We assessed the relationship between transfusion and rates of 30-day and 1-year ischemic events and mortality in patients with ACS in the ACUITY trial.

  6. Baseline Characteristics

  7. Transfusion (N=319) No Transfusion (N=13,500) 29.5% P <0.0001 all 18.8% 30-day event rates 11.3% 9.4% 7.1% 4.8% 2.3% 1.3% Composite Death MI (all) Unplanned Ischemia Revasc Transfusion and 30-Day Event Rates

  8. Transfusion (N=319) No Transfusion (N=13,500) P <0.0001 both 40.1% 1-year event rates 21.9% 15.1% 3.4% Composite Ischemia Death Transfusion and 1-Year Event Rates

  9. UFH/Enox+GPI (N=4603) Bivalirudin+GPI (N=4604) Bivalirudin alone (N=4612) P=0.0003 P=0.0003 P=0.70 P=0.70 2.7% 2.6% 30-Day event rates 1.6% Transfusion 30-Day Transfusion Rates by Treatment

  10. Risk ratio Risk ratio ± ± 95% CI 95% CI RR (95% CI) P - value Age Age > > 75 (vs. 55 75 (vs. 55 - - 75) 75) 1.42 (1.06 1.42 (1.06 - - 1.91) 1.91) 0.0006 0.0006 Anemia Anemia 3.76 (2.92 3.76 (2.92 - - 4.86) 4.86) <0.0001 <0.0001 CrCl <60mL/min CrCl <60mL/min 2.10 (1.57 2.10 (1.57 - - 2.80) 2.80) <0.0001 <0.0001 Diabetes Diabetes 1.56 (1.21 1.56 (1.21 - - 2.01) 2.01) 0.0060 0.0060 Female gender Female gender 2.23 (1.74 2.23 (1.74 - - 2.87) 2.87) <0.0001 <0.0001 High High - - risk (ST / biomarkers) risk (ST / biomarkers) 1.75 (1.30 1.75 (1.30 - - 2.37) 2.37) 0.0003 0.0003 Hypertension Hypertension 1.46 (1.05 1.46 (1.05 - - 2.02) 2.02) 0.0241 0.0241 Heparin(s) + GPI (vs. Bivalirudin) Heparin(s) + GPI (vs. Bivalirudin) 1.73 (1.26 1.73 (1.26 - - 2.38) 2.38) 0.0007 0.0007 0 1 2 3 4 5 Baseline Independent Predictors of 30-Day Transfusion

  11. Independent Predictors of 1-Year Mortality

  12. CONCLUSIONS • Blood product transfusion is associated with increased rates of 30-day and 1-year composite ischemic events and mortality in patients with ACS. • Transfusion rates are significantly lower in patients treated with bivalirudin alone compared to those treated with heparin plus a GPI. • Transfusion is a significant independent predictor of 1-year mortality in patients with ACS.

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