Early Aspirin Discontinuation Safe After Complete Revascularization In Acute Mi

Among low-risk patients pinch acute MI who underwent early complete revascularization and received 1 period of dual antiplatelet therapy (DAPT), P2Y12 inhibitor monotherapy was noninferior to continued DAPT for adverse cardiovascular and cerebrovascular events, while reducing bleeding risk. These late-breaking findings were presented successful a Hot Line convention coming astatine ESC Congress 2025 and simultaneously published successful New England Journal of Medicine.

Current ESC Guidelines urge 12 months of DAPT − aspirin positive a potent P2Y12 inhibitor − aft percutaneous coronary involution (PCI) for MI. 

No randomized tests person antecedently assessed early aspirin discontinuation successful acute MI patients who execute early, complete revascularization pinch modern stents. In specified cases, bleeding consequence whitethorn outweigh residual ischaemic risk, making antiplatelet therapy de-escalation attractive."

Professor Giuseppe Tarantini, Principal Investigator of nan TARGET-FIRST trial, University of Padua, Italy

In this open-label randomized controlled proceedings conducted astatine 40 European centres, eligible adults pinch an ST-segment elevation MI (STEMI) aliases non-STEMI underwent complete revascularization wrong 7 days utilizing a modern drug-eluting stent and completed 1 period of DAPT without adverse events. They were randomized 1:1 to proceed DAPT aliases move to P2Y12 inhibitor monotherapy for 11 months. The superior endpoint was a composite of all-cause death, MI, stent thrombosis, changeable aliases Bleeding Academic Research Consortium (BARC) type 3/5 bleeding astatine 11 months. Noninferiority was defined arsenic an absolute quality ≤1.25 percent points successful nan precocious bound of nan two-sided 95% CI.

The mean property of nan 1,942 randomized patients was 61 years and 21.6% were women.

The superior endpoint occurred successful 2.10% of nan P2Y12 inhibitor monotherapy group and 2.18% of nan continued DAPT group (difference -0.09 percent points; 95% CI -1.39 to 1.20; p=0.021 for noninferiority). MI occurred successful 0.7% vs. 1.1%, definite/probable stent thrombosis successful 0.1% vs. 0.0% and ischaemic changeable successful 0.3% vs. 0.2%, respectively. BARC type 3/5 bleeding occurred successful 0.7% successful each group.

The main secondary endpoint (BARC type 2/3/5 bleeding) was importantly little pinch P2Y12 inhibitor monotherapy (2.65% vs. 5.57%; hazard ratio [HR] 0.46; 95% CI 0.29 to 0.75; p=0.002). The patient-oriented composite result (all-cause death, MI, stent thrombosis, stroke, repetition ischaemia-driven revascularization aliases BARC type 2/3/5 bleeding) occurred successful 4.5% successful nan monotherapy group and 7.2% successful nan DAPT group (HR 0.61; 95% CI 0.42 to 0.89). Therapy adherence astatine 11 months was precocious successful some groups (86.9% pinch monotherapy and 88.6% pinch DAPT).

Professor Tarantini concluded: "In low-risk acute MI patients pinch early complete revascularization and nary complications aft 1 period of DAPT, switching to P2Y12 inhibitor monotherapy-maintained protection from ischaemic events and reduced bleeding. These results bespeak nan benefits of modern stents, precocious procedural occurrence and optimal aesculapian therapy, making early aspirin discontinuation feasible successful this selected population."