The ACUITY trial in ACS (13819 patients, 3852 with diabe- tes mellitus) reported that 30-day adverse clinical outcomes (death, MI, or unplanned revascularization) or major bleeding were increased in patients with diabetes mellitus (12.9% ver- Bivalirudin plus a GP IIb/IIIa inhibitor resulted in increased similar rates of the composite ischemia compared with heparin plus a GP IIb/IIIa inhibitor. Bivalirudin alone was associated with a similar increased rate of composite ischemia but less major bleeding (3.7% versus 7.1%; P<0.001). Several studies evaluated the benefit of oral antiplatelet ther- apy duringACS in patients with diabetes mellitus. In TRITON- TIMI 38, patients with diabetes mellitus had a greater reduction in ischemic events without an observed increase in TIMI major bleeding with prasugrel compared with clopidogrel.618 In PLATO, ticagrelor compared with clopidogrel reduced isch- emic events irrespective of diabetic status and glycemic con- trol, without an increase in major bleeding.619 See Online Data Supplement 27 for additional information on diabetes mellitus. 7.4. Post CABG: Recommendation Class I 1. Patients with prior CABG and NSTE-ACS should receive antiplatelet and anticoagulant therapy ac- cording to GDMT and should be strongly considered for early invasive strategy because of their increased (Level of Evidence: B) Although CABG reduces morbidity and mortality in selected patients with complex CAD, they remain at risk for develop- ment of disease progression of ungrafted native vessels or significant atherothrombotic disease in saphenous vein grafts and subsequent ACS. These patients constitute a higher-risk groupbecausetheyhavealreadyundergoneCABG,typicallyfor more extensive CAD, and they have more comorbidities.620 624 In the PURSUIT trial, 12%1,134 of the patients had prior CABG and more adverse follow-up outcomes, including increased mortality, but had a benefit with eptifibatide similar to those without prior CABG.622 Patients with prior CABG are less likely to undergo early catheterization after NSTEMI. 