Potent P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy (DAPT) After PCI in Patients With and Without STEMI: The NEO-MINDSET Substudy
Authors' conclusion
In patients with STEMI treated with percutaneous coronary intervention, early aspirin withdrawal may be harmful, because it increases the risk of ischemic events. Conversely, in NSTE-ACS, potent P2Y12 inhibitor monotherapy may be a viable therapeutic option: Ischemic event rates were similar and bleeding was reduced compared with DAPT.
Study context
- Population
- Acute coronary syndrome (ACS) patients undergoing PCI, by presentation: STEMI or NSTE-ACS (unstable angina or NSTEMI; n = 1,291)STEMI 2,119
- Participants
- 3,410 patients
- Comparison
- Potent P2Y12 inhibitor monotherapy vs DAPT, by STEMI vs NSTE-ACS presentation
- Primary endpoint
- Co-primary: ischemic composite (all-cause death, MI, stroke, urgent target vessel revascularization) and BARC type 2, 3 or 5 bleeding
- Follow-up
- 1 year
Primary result
As reported in the abstract
Co-primary ischemic composite, by presentation
Monotherapy vs DAPTHazard ratio (95% CI)
STEMI: 8.2% vs 5.2%
1.60(1.14–2.24)
NSTE-ACS: 5.1% vs 6.0%
0.84(0.53–1.35)
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Co-primary BARC type 2, 3 or 5 bleeding, by presentationMonotherapy vs DAPT · STEMI | 0.37 (0.22–0.61) | |
| Co-primary BARC type 2, 3 or 5 bleeding, by presentationMonotherapy vs DAPT · NSTE-ACS | 0.45 (0.23–0.86) | |
| 0.20.5125Hazard ratio (log scale) |
- Co-primary BARC type 2, 3 or 5 bleeding, by presentation: P for interaction = 0.650
Original publication
Potent P2Y12 Inhibitor Monotherapy vs DAPT After PCI in Patients With and Without STEMI: The NEO-MINDSET Substudy. J Am Coll Cardiol. Published 18 November 2025. doi:10.
Summarised from the published abstract; every number is checked against it