The optimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remains a key clinical question. A new study, the TARGET-FIRST trial, investigated whether transitioning to P2Y12 inhibitor monotherapy after one month is a safe and effective strategy for low-risk patients.¹

TARGET-FIRST (NCT04753749) was a multicentre, open-label, randomised trial conducted at 40 European sites. The study enrolled adults with AMI who had undergone successful complete revascularisation within seven days of the event and had completed one month of DAPT without any ischaemic or major bleeding complications.

A total of 1,942 patients were randomised to one of two groups for an additional 11 months: P2Y12 inhibitor monotherapy (n=961) or continued DAPT (n=981).

The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, stroke, or major bleeding, as defined by the Bleeding Academic Research Consortium (BARC) as type 3 or 5. This was tested for noninferiority with a margin of 1.25 percentage points. The main secondary outcome, tested for superiority, was clinically relevant bleeding (BARC type 2, 3, or 5).

The trial met its primary endpoint for noninferiority. A primary outcome event occurred in 20 patients (2.1%) in the P2Y12 inhibitor monotherapy group compared to 21 patients (2.2%) in the DAPT group (difference, −0.09 percentage points; 95% CI, −1.39 to 1.20; p=0.02 for noninferiority).

For the main secondary outcome, P2Y12 inhibitor monotherapy was found to be superior in reducing bleeding events. Clinically relevant bleeding (BARC type 2, 3, or 5) occurred in 2.6% of patients in the monotherapy group versus 5.6% in the DAPT group (HR 0.46; 95% CI, 0.29 to 0.75; p=0.002).

The incidence of stent thrombosis was infrequent and similar between the two groups, as was the incidence of serious adverse events.

These findings suggest that for a select group of low-risk patients with AMI, an abbreviated DAPT strategy is a viable option. According to the TARGET-FIRST investigators, “Among low-risk patients with acute myocardial infarction who had undergone early complete revascularization and had completed 1 month of dual antiplatelet therapy without complications, P2Y12-inhibitor monotherapy was noninferior to continued dual antiplatelet therapy with respect to the occurrence of adverse cardiovascular and cerebrovascular events and resulted in a lower incidence of bleeding events.”

This study was funded by MicroPort (France).

References

1. Tarantini G, Honton B, Paradies V, et al. Early Discontinuation of Aspirin after PCI in Low-Risk Acute Myocardial Infarction. N Engl J Med. 2025. https://doi.org/10.1056/NEJMoa2508808.

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