OBJECTIVES: Percutaneous Coronary Intervention (PCI) is used to treat Acute Coronary Syndrome (ACS). Currently ACCF/AHA/SCAI PCI guidelines recommend use of antithrombin agents (bivalirudin or heparin) in combination with antiplatelet agents (oral P2Y12 inhibitors and/or GPIIb/IIIa inhibitors).  Bivalirudin has demonstrated reduced bleeding events vs. heparin+GPI; though, GPI use has declined over the past 10 years.  Cangrelor, a novel, rapid on/off-set IV P2Y12, reduced ischemic events vs. clopidogrel in the CHAMPION program.  The aim of our analysis was to quantify the impact of using cangrelor and bivalirudin together in PCI from a US hospital perspective.  METHODS: A decision analytic model based on current clinical practice was developed to estimate the annual impact of using heparin+/-GPI+/-clopidogrel (base case) vs. bivalirudin+cangrelor+bailout GPI (scenario).  We used data from RCTs to estimate event rates (mortality, myocardial infraction, stent thrombosis, ischemia-driven revascularization, and major/minor bleeding). Patient and GPI mix was derived from an analysis of Premier’s Perspectives Database.  GPI use in cangrelor patients was based on the CHAMPION Phoenix study. Event costs were obtained from published literature and inflation-adjusted to 2013 dollars.  Drug costs were based on 2013 wholesale acquisition costs.  To estimate the clinical value of using bivalirudin+cangrelor, we set their costs to $0. RESULTS: For a hypothetical cohort of 1,000 PCI patients/year (STEMI=6.4%, NSTEMI/UA=16.7%, stable angina=76.9%) treated with heparin+/-GPI (weighted average of 30.0% GPI use across diagnoses), use of bivalirudin+cangrelor+2.8% GPI provided a hospital $0.95MM in clinical value.  Cost-offsets were derived from a reduction in GPI use, lower ischemic and bleeding events. Sensitivity was assessed in using heparin+/-GPI; GPI%=70.6% (extreme from APEX-AMI trial) vs. bivalirudin+cangrelor+9.7% GPI where the clinical value was estimated at $1.59MM.  CONCLUSIONS: Use of bivalidudin+cangrelor during PCI delivers an estimated clinical value of at least $950 per PCI-patient, $1,590 in STEMI patients with improved clinical outcomes.