Potent P2Y₁₂ Inhibitor Monotherapy vs DAPT After PCI in Patients With and Without STEMI: The NEO-MINDSET Substudy

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI).
• Early aspirin withdrawal with P2Y12 inhibitor monotherapy is being explored.
• Its efficacy may vary based on acute coronary syndrome (ACS) type.

Purpose of the Study:

• To evaluate if early aspirin discontinuation effects differ between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS).
• This is a prespecified analysis of the NEO-MINDSET trial.
• Comparing potent P2Y12 inhibitor monotherapy vs. DAPT in ACS patients.

Main Methods:

• Randomized controlled trial (NEO-MINDSET) comparing monotherapy vs. DAPT.
• Patients received potent P2Y12 inhibitor monotherapy or DAPT (aspirin + P2Y12 inhibitor) for 12 months.
• Co-primary outcomes: composite ischemic events and BARC 2, 3, or 5 bleeding.

Main Results:

• STEMI patients on monotherapy had higher ischemic event rates vs. DAPT (8.2% vs. 5.2%).
• NSTE-ACS patients showed similar ischemic event rates between monotherapy and DAPT (5.1% vs. 6.0%).
• Monotherapy significantly reduced bleeding events in both STEMI and NSTE-ACS populations compared to DAPT.

Conclusions:

• Early aspirin withdrawal may be detrimental in STEMI patients post-PCI, increasing ischemic risk.
• Potent P2Y12 inhibitor monotherapy is a viable option for NSTE-ACS patients.
• Monotherapy reduces bleeding without compromising ischemic outcomes in NSTE-ACS.