Coronary disease & ACSSecondary analysis
Potent P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy (DAPT) After PCI in Patients With and Without STEMI
- Prespecified subgroup analysis of the NEO-MINDSET randomised trial
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 presentation — Monotherapy vs DAPT · STEMI | 0.37 (0.22–0.61) | |
| Co-primary BARC type 2, 3 or 5 bleeding, by presentation — Monotherapy 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. J Am Coll Cardiol. Published 18 November 2025. doi:10.1016/j.jacc.2025.10.058
Summarised from the published abstract; every number is checked against it