OBJECTIVES: In the PURSUIT trial, eptifibitide was found to reduce the risk of acute myocardial infarction (AMI) and mortality (composite) from 15.7% to 14.2% (relative risk reduction [RRR] = 9.5 percent) in patients presenting with non-ST elevation acute cardiac ischemia (ACI). A cost-effectiveness analysis, based on the more favorable United States (US) results of the trial, found that the cost-effectiveness ratio for eptifibitide for this indication was $16,491 per year of life saved. We sought to estimate the cost-effectiveness of eptifibitide based on the results of the entire trial and the expected risk of AMI/death in a community based-sample of patients. METHODS: Based on logistic regression equations to predict patient-specific risks of AMI and death using easily obtainable clinical and electrocardiograph characteristics (and assuming a constant RRR), we estimated the cost-effectiveness of routine use of eptifibitide in individuals in a population of 2,781 consecutive patients admitted for non-ST elevation ACI. RESULTS: Predictions were obtained on 2,578 (92.7 percent) of patients who met inclusion criteria. Of these patients, 1.9 percent died at 30 days and 12.2 percent had the composite outcome of AMI or death. Given these overall risks and a constant RRR, the average cost per year of life saved in our sample was estimated to be $42,469 per QALY. Moreover, adjusting each patients risk of AMI and death using individual patient characteristics, only 7 percent of patients were at sufficiently high-risk to warrant therapy under a threshold of $20,000 per QALY and 42 percent under a threshold of less than $50,000 per QALY. CONCLUSION: Given a constant RRR, use of eptifibitide is economically attractive in high-risk patients, but much less attractive in low risk patients. Strategies to risk stratify patients to optimize clinical and economic outcomes should be considered.