Summary

The HORIZONS AMI trial showed that bivalirudin therapy in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PCI) reduced mortality and bleeding for up to 3 years compared with heparin plus a glycoprotein IIb/IIIa inhibitor [Stone GW et al. N Engl J Med 2008]. However, according to the results of the European Ambulance Acute Coronary Syndrome Angiography Trial [EUROMAX; Steg PG et al. N Engl J Med 2013], several issues remain. The objective of the EUROMAX trial was to examine whether bivalirudin, initiated in patients with STEMI while being transported in the ambulance for primary PCI, was superior to heparin and provisional use of glycoprotein IIb/IIIa inhibitors.