Overview

• NEO-MINDSET found that starting aspirin-free P2Y12 monotherapy immediately after ACS PCI failed to meet noninferiority for ischaemic events (7.0% vs 5.5%), though bleeding was lower (2.0% vs 4.9%) with excess ischaemic risk concentrated in the first 30 days.
• In TARGET-FIRST, low-risk MI patients with early complete revascularization who switched to P2Y12 monotherapy after one month of event-free DAPT had noninferior composite outcomes versus continued DAPT and less BARC 2/3/5 bleeding (2.65% vs 5.57%).
• TACSI showed no reduction in major adverse cardiovascular events with 12-month ticagrelor plus aspirin versus aspirin alone after CABG for ACS, with more major bleeding on DAPT (4.9% vs 2.0%).
• TOP-CABG demonstrated that de-escalation after CABG (three months ticagrelor plus aspirin followed by aspirin) was noninferior for saphenous vein graft occlusion at one year and cut clinically relevant bleeding (8.26% vs 13.19%).
• TAILORED-CHIP reported no net clinical benefit from early escalation then late de-escalation in complex high-risk PCI, with higher clinically relevant bleeding versus standard 12-month clopidogrel plus aspirin (7.2% vs 4.8%).