Bivalirudin versus heparin with or without glycoprotein Ⅱb/Ⅲa inhibitors in?patients with STEMI undergoing primary percutaneous coronary intervention:Pooled patient-level analysis from the

In the HORIZONS-AMI （Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction） trial, 3,602 patients undergoing primary percutaneous coronary intervention （PCI） for ST-segment elevation myocardial infarction （STEMI） treated with bivalirudin had lower bleeding and mortality rates, but higher acute stent thrombosis rates compared with heparin ＋ a glycoprotein Ⅱ b/Ⅲ a inhibitor （GPI）. Subse- quent changes in primary PCI, including the use of potent P2Y_12 inhibitors, frequent radial intervention, and pre-hospital medication administration, were incorporated into the EUROMAX （European Ambulance Acute Coronary Syndrome Angiography） trial, which assigned 2,218 patients to bivalirudin versus heparin ±GPI before primary PCI.