Abstract： Objective To evaluate the efficacy and safety of bivalirudin and heparin in patients with ST-elevation myocardial infarction (STEMI).Methods Literatures of clinical randomized controlled trails of bivalirudin versus heparin treating STEMI patients during percutaneous coronary intervention published before June 2017 on China National Knowledge Infrastructure(CNKI),CBMdisc,Wanfang,VIP,PubMed,Cochrane Library and Embase were searched by computer and manual review.The RevMan 5.1 software was used for meta analysis.Results Five literatures of 6 randomized controlled trials were included;10 740 patients were included in total,with 5 375 patients in bivalirudin group and 5 365 patients in heparin group.Results of meta analysis showed that the long-term death rate(risk ratio =0.71,95％ confidence interval:0.54-0.93,P =0.01,I2 =0％),short-term hemorrhage rate(risk odds ratio =0.64,95％ confidence interval:0.42-0.97,P =0.04,I2 =75％) and long-term hemorrhage rate (risk ratio =0.44,95％ confidence interval:0.23-0.84,P =0.01,I2 =50％) in bivalirudin group were significantly lower than those in heparin group.However,the short-term recurrent myocardial infarction rate in bivalirudin group was significantly higher than that in heparin group(risk ratio =1.47,95％ confidence interval:1.10-1.96,P =0.008,I2 =34％).Conclusion Bivalirudin can reduce short-and long-term hemorrhage and long-term mortality but increase short-term recurrent myocardial infarction compared with heparin.