It's the first time in nine all-time tries East Carolina (9-12, 2-6 American) has beaten Cincinnati.
The Pirates trailed 46-39 with 3:23 left but scored the last 11 points of the game as the Bearcats missed their last four shots.
Scoring was at a premium in the first half, as both teams had just one basket over the first 4:50. Once they got warmed up, Cincinnati made five shots in a row and led 15-8 at the midway mark, then scored the last six points of the half to lead 23-18 at the break.
Octavius Ellis recorded his first career Division I double-double with 14 points and a career-high 14 rebounds for Cincinnati (15-6, 6-3). Ellis was 5 of 6 from the floor and 4 of 4 at the line.