External validation of the BRIGHT-4 results shows that patients with ST-segment myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) who receive bivalirudin plus a high-dose infusion 2- to 4-hours post-PCI have reduced cardiac mortality and major bleeding, and no increase in ischemic events, compared with patients who receive heparin monotherapy with provisional glycoprotein IIb/IIIa inhibitor (GPI) use.