- Question
- To determine whether switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy (DAPT) reduces net adverse clinical events compared with ticagrelor-based 12-month DAPT in patients with acute coronary syndrome (ACS) treated with drug-eluting stents.
- Design
- Randomized, multicenter, open-label (unmasked) trial of 3056 patients with ACS enrolled at 38 centers in South Korea between August 2015 and October 2018. Primary follow-up was 1 year; 97.4% of patients completed the trial.
- Population
- Patients with acute coronary syndrome treated with drug-eluting stents; mean age 61 years, 20% women, and 36% with ST-elevation myocardial infarction.
- Intervention
- Ticagrelor monotherapy (90 mg twice daily) after 3 months of DAPT (n = 1527).
- Control
- Ticagrelor-based 12-month DAPT, i.e., ticagrelor plus aspirin (n = 1529).
- Primary outcome
- One-year net adverse clinical event, defined as a composite of major bleeding and adverse cardiac and cerebrovascular events (death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization).
- Results
- The primary outcome occurred in 59 patients (3.9%) with monotherapy and 89 (5.9%) with 12-month DAPT (absolute difference -1.98%; 95% CI -3.50% to -0.45%; HR 0.66; 95% CI 0.48 to 0.92; P = .01). Major bleeding occurred in 1.7% vs 3.0% (HR 0.56; 95% CI 0.34 to 0.91; P = .02).
- Safety
- The reduction in major bleeding was the main safety finding. Major adverse cardiac and cerebrovascular events did not differ significantly (2.3% vs 3.4%; HR 0.69; 95% CI 0.45 to 1.06; P = .09).
- Conclusion
- In ACS patients treated with drug-eluting stents, ticagrelor monotherapy after 3 months of DAPT produced a modest but significant reduction in the composite of major bleeding and cardiovascular events at 1 year, with caveats regarding the study population and lower-than-expected event rates.
- Why it matters
- It supported the strategy of stopping aspirin early and continuing a potent P2Y12 inhibitor alone as a way to reduce bleeding in ACS, without evidence of lost ischemic protection.
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 14, 2026