- Question
- In low-risk patients with acute myocardial infarction, early complete revascularization and a contemporary drug-eluting stent, can aspirin be stopped at 1 month in favor of P2Y12-inhibitor monotherapy rather than continuing dual antiplatelet therapy?
- Design
- Multicenter, open-label, randomized trial at 40 European sites. A total of 1942 patients were randomized (961 to P2Y12-inhibitor monotherapy and 981 to continued dual antiplatelet therapy), with follow-up of 11 months after randomization.
- Population
- Adults with acute myocardial infarction who had successful complete revascularization within 7 days of the infarction and completed 1 month of dual antiplatelet therapy without ischemic events or major bleeding.
- Intervention
- Transition to P2Y12-inhibitor monotherapy (aspirin discontinuation) after the first month of dual antiplatelet therapy.
- Control
- Continued dual antiplatelet therapy for an additional 11 months.
- Primary outcome
- Composite of death from any cause, myocardial infarction, stent thrombosis, stroke, or major bleeding (BARC type 3 or 5) at 11 months after randomization, tested for noninferiority with a margin of 1.25 percentage points.
- Results
- A primary-outcome event occurred in 20 patients (2.1%) with monotherapy and in 21 (2.2%) with dual antiplatelet therapy (difference, -0.09 percentage points; 95% CI, -1.39 to 1.20; P = 0.02 for noninferiority). BARC type 2, 3, or 5 bleeding occurred in 2.6% with monotherapy versus 5.6% with dual antiplatelet therapy (HR, 0.46; 95% CI, 0.29 to 0.75; P = 0.002 for superiority).
- Safety
- Stent thrombosis was infrequent and similar between groups; serious adverse events appeared similar in both groups.
- Conclusion
- In low-risk patients with acute myocardial infarction and early complete revascularization, P2Y12-inhibitor monotherapy after 1 month of dual antiplatelet therapy was noninferior to continued dual therapy for adverse cardiovascular and cerebrovascular events and reduced bleeding.
- Why it matters
- It supports shortening dual antiplatelet therapy in a selected low-risk group after myocardial infarction, lowering bleeding without increasing ischemic events in this setting.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026