TARGET-FIRST: PCI-treated patients after low-risk MI with infrequent events and similar outcomes with early aspirin discontinuation

In patients with acute myocardial infarction (MI) at low ischaemic risk who were treated with percutaneous coronary intervention (PCI) and had no complications after 1 month, monotherapy with a P2Y₁₂ inhibitor was non-inferior to dual antiplatelet therapy (DAPT) for ischaemic events and superior in reducing bleeding at 1 year of follow-up.

“The new-generation drug-eluting stents are associated with a reduction in stent thrombosis, which has sparked interest in shorter DAPT duration,” explained Prof. Giuseppe Tarantini (University of Padua, Italy) [1]. He noted that the TARGET-FIRST (NCT04753749) trial enrolled participants with acute MI at low ischaemic risk who underwent PCI. “Complete revascularisation was performed early and a modern drug-eluting stent was used,” he added. Thereafter, participants received one month of DAPT. If no complications occurred during this period, they were randomised (n=1,942) 1:1 to P2Y12 inhibitor monotherapy or DAPT.

The primary outcome was a composite of all-cause death, myocardial infarction, stent thrombosis, stroke, or major bleeding (BARC type 3 or 5). It was tested for non-inferiority at the 1-year follow-up. A total of 41 primary outcome events occurred across both groups. The event rate was 2.1% in the monotherapy arm and 2.2% in the DAPT arm (20 vs 21 events, delta -0.09; 95% CI -1.39 to 1.20; non-inferiority P=0.021). The secondary endpoint of bleeding (BARC type 2,3, or 5) was then tested for superiority. The bleeding rate was significantly lower in the monotherapy group (2.6% vs 5.6%; HR 0.46; 95% CI 0.29-0.75; P=0.002). In particular, the rate of BARC type 2 bleeding was higher in the DAPT arm compared with monotherapy (4.8% vs 1.9%).

“These findings suggest that when complete revascularisation is combined with personalised pharmacotherapy, short-term DAPT, followed by P2Y12 inhibitor monotherapy emerges as a safe and effective strategy for carefully selected patients,” concluded Prof. Tarantini.

1. Tarantini G, et al. Early aspirin discontinuation following PCI in low-risk acute MI patients: results from the TARGET-FIRST trial. Hotline 7, ESC Congress 2025, 29 August – 1 September, Madrid, Spain.

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Posted on 7 November 20257 November 2025