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Amongst low-risk sufferers with acute MI who underwent early full revascularization and acquired one month of twin antiplatelet remedy (DAPT), P2Y12 inhibitor monotherapy was noninferior to continued DAPT for adversarial cardiovascular and cerebrovascular occasions, whereas lowering bleeding danger.
These late-breaking findings had been introduced in a Scorching Line session on the ESC Congress 2025 and concurrently printed within the New England Journal of Medication.
Present ESC Tips advocate 12 months of DAPT—aspirin plus a potent P2Y12 inhibitor—after percutaneous coronary intervention (PCI) for MI.
Principal Investigator of the TARGET-FIRST trial, Professor Giuseppe Tarantini from the College of Padua, Italy, defined, “No randomized trials have previously assessed early aspirin discontinuation in acute MI patients who achieve early, complete revascularization with modern stents. In such cases, bleeding risk may outweigh residual ischemic risk, making antiplatelet therapy de-escalation attractive.”
On this open-label randomized managed trial performed at 40 European facilities, eligible adults with an ST-segment elevation MI (STEMI) or non-STEMI underwent full revascularization inside seven days utilizing a recent drug-eluting stent and accomplished one month of DAPT with out adversarial occasions.
They had been randomized 1:1 to proceed DAPT or swap to P2Y12 inhibitor monotherapy for 11 months. The first endpoint was a composite of all-cause demise, MI, stent thrombosis, stroke or Bleeding Educational Analysis Consortium (BARC) kind 3/5 bleeding at 11 months. Noninferiority was outlined as an absolute distinction of ≤1.25 proportion factors within the higher sure of the two-sided 95% CI.
The imply age of the 1,942 randomized sufferers was 61 years and 21.6% had been ladies.
The first endpoint occurred in 2.10% of the P2Y12 inhibitor monotherapy group and a pair of.18% of the continued DAPT group (distinction –0.09 proportion factors; 95% CI,1.39 to 1.20; p=0.021 for noninferiority). MI occurred in 0.7% vs. 1.1%, particular/possible stent thrombosis in 0.1% vs. 0.0% and ischemic stroke in 0.3% vs. 0.2%, respectively. BARC kind 3/5 bleeding occurred in 0.7% in every group.
The principle secondary endpoint (BARC kind 2/3/5 bleeding) was considerably decrease with 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 consequence (all-cause demise, MI, stent thrombosis, stroke, repeat ischemia-driven revascularization or BARC kind 2/3/5 bleeding) occurred in 4.5% within the monotherapy group and seven.2% within the DAPT group (HR 0.61; 95% CI, 0.42 to 0.89). Remedy adherence at 11 months was excessive in each teams (86.9% with monotherapy and 88.6% with DAPT).
Professor Tarantini concluded, “In low-risk acute MI sufferers with early full revascularization and no problems after one month of DAPT, switching to P2Y12 inhibitor monotherapy maintained safety from ischemic occasions and decreased bleeding.
“These results reflect the benefits of modern stents, high procedural success and optimal medical therapy, making early aspirin discontinuation feasible in this selected population.”
Extra info:
Giuseppe Tarantini et al, Early Discontinuation of Aspirin after PCI in Low-Threat Acute Myocardial Infarction, New England Journal of Medication (2025). DOI: 10.1056/NEJMoa2508808
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European Society of Cardiology
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Early aspirin discontinuation linked to advantages in low-risk sufferers with myocardial infarction (2025, September 1)
retrieved 1 September 2025
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