This is a summary of the post-hoc analysis of the TARGET-FIRST study, presented by Dr. Giuseppe Tarantini at EuroPCR 2026, evaluating early aspirin discontinuation after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).
Current guidelines generally recommend 12 months of dual antiplatelet therapy (DAPT) after myocardial infarction. This study assessed whether shortening DAPT to just 1 month, followed by P2Y12 inhibitor monotherapy, is a safe and effective strategy, particularly in patients at higher ischemic risk.
A total of 2,246 AMI patients undergoing PCI with a new-generation stent (Firehawk) were analyzed. After completing one event-free month of DAPT, patients (n=1,942) were randomized to either P2Y12 inhibitor monotherapy (aspirin discontinued) through 11 months or standard DAPT (continued aspirin plus P2Y12 inhibitor) for the same duration.
The primary endpoint (PEP) was the rate of MACCE, defined as all-cause death, myocardial infarction, stent thrombosis, stroke, or major bleeding at 11 months.
This specific analysis stratified patients according to ESC (European Society of Cardiology) criteria:
- High ischemic risk (27% of the population): included factors such as multivessel disease, insulin-treated diabetes, total stent length >60 mm, or prior myocardial infarction.
- Low ischemic risk (73% of the population).
Read also: EuroPCR 2026 | Could clopidogrel replace aspirin as monotherapy after PCI?
Regarding the results, shortening DAPT was not associated with an increase in ischemic events (MACE), regardless of whether patients were classified as high or low ischemic risk. In contrast, P2Y12 inhibitor monotherapy significantly reduced clinically relevant bleeding in both risk groups. In the main study, a 54% relative reduction in bleeding risk was observed.
Furthermore, there was no significant interaction between ischemic risk level and treatment benefit, suggesting that the short DAPT strategy performed consistently across the entire study population.
Conclusions: Early Aspirin Discontinuation May Reduce Bleeding Without Increasing Ischemic Events
In myocardial infarction patients who remain event-free during the first month after complete revascularization, shortening DAPT to one month provides a clear bleeding reduction benefit without increasing the risk of ischemic complications, even among patients with a higher ischemic risk profile.
Original Title: Early Aspirin Cessation After PCI in AMI: TARGET-FIRST Analysis.
Reference: Presentado por el Dr. Giuseppe Tarantini en el Congreso EuroPCR 2026.
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