Overview

• In TARGET-FIRST, stopping aspirin after one month and continuing a P2Y12 inhibitor in low-risk, fully revascularized MI patients was noninferior to 12 months of dual therapy for the composite of ischemic and major bleeding events (2.10% vs 2.18%; p=0.021 for noninferiority).
• TARGET-FIRST also showed less clinically relevant bleeding with monotherapy, with BARC 2/3/5 events at 2.65% versus 5.57% on continued dual therapy (HR 0.46; p=0.002).
• The DUAL-ACS all-comer trial signaled lower all-cause mortality with three months of dual therapy versus 12 months (2.7% vs 3.4%; HR 0.78; p=0.1232) and fewer major bleeds (3.2% vs 4.0%; HR 0.78; p=0.0977) but was under-recruited and inconclusive.
• In high-risk complex PCI, TAILORED-CHIP found no net clinical benefit from early escalation with low-dose ticagrelor plus aspirin followed by clopidogrel monotherapy, and it increased clinically relevant bleeding (7.2% vs 4.8%; p=0.002).
• The findings, presented at ESC Congress 2025, question a universal 12‑month dual antiplatelet strategy after MI and highlight the importance of patient selection based on ischemic and bleeding risk.