Study Title: TARGET-FIRST: Early aspirin discontinuation after PCI in acute MI patients

Congress: ESC Congress 2025

Link: https://esc365.escardio.org/presentation/312212

Prepared by: Dr. Yusuf Uyanık, Dr. Mustafa Yenerçağ

Introduction:
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients remains debated. With the use of contemporary drug-eluting stents and guideline-recommended complete revascularization strategies, defining the most appropriate treatment approach is of significant clinical importance.

Objective:
The aim of this study was to evaluate the efficacy and safety of P2Y12 inhibitor monotherapy compared with DAPT in AMI patients who underwent successful early complete revascularization and completed one month of DAPT without complications.

Methods:
This multicenter, open-label, randomized study was conducted across 40 European centers. A total of 1,942 patients who experienced AMI, underwent successful complete revascularization within 7 days, and completed 1 month of DAPT without ischemic events or major bleeding were randomized. Patients were assigned to either P2Y12 inhibitor monotherapy (n=961) or an additional 11 months of DAPT (n=981). The primary endpoint was a composite of death, myocardial infarction, stent thrombosis, stroke, or BARC type 3/5 major bleeding within 11 months. The secondary endpoint was clinically significant bleeding defined as BARC type 2/3/5.

Results:
The primary endpoint occurred in 2.1% of the monotherapy group and 2.2% of the DAPT group (difference: –0.09 percentage points; 95% CI: –1.39 to 1.20; noninferiority P=0.02). Clinically significant bleeding was observed in 2.6% of the monotherapy group and 5.6% of the DAPT group (HR: 0.46; 95% CI: 0.29–0.75; superiority P=0.002). Stent thrombosis was rare and occurred at similar rates in both groups.

Conclusions:
P2Y12 inhibitor monotherapy was found to be noninferior to DAPT for cardiovascular and cerebrovascular events in low-risk AMI patients who underwent complete revascularization, while significantly reducing the risk of bleeding.

Commentary:
These findings suggest that transitioning from DAPT to P2Y12 inhibitor monotherapy after an uncomplicated early phase may be a safe approach associated with lower bleeding risk. The results highlight the importance of implementing personalized antiplatelet strategies in clinical practice.