Abstract: AIM AIMTo evaluate the efficiency and safety of bivalirudin during percutaneous coronary intervention (PCI) in elderly patients (Age>65) with acute coronary syndrome (ACS). METHODS Medical records were analyzed in 35 patients given bivalirudin during PCI. The same type of records were screened in which unfractionated heparin (UFH) was used during PCI at a ratio of 1∶1 for a control group of 35 patients.The main endpoint events included major adverse cardiac and cerebrovascular events (MACCE) and severe bleeding complications at 30 days. RESULTS There were no significant differences between the two groups.The incidences of MACCE (11% vs. 14%), which was 4 for bivalirudin and 5 for heparin at 30 days, demonstrated no statistical significance.The incidences of bleeding (3% vs. 17%, P<0.05), which was 1 for bivalirudin and 6 for heparin, showed that the bivalirudin group is superior to the heparin group. CONCLUSION The use of bivalirudin resulted in a decrease in bleeding events without significant difference in MACCE compared with heparin alone at 30 days.