Aspirin withdrawal after primary PCI for STEMI: timing matters

Antithrombotic management in the early days after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) requires a careful balance between ischaemic protection and bleeding risk. Potent P2Y12 inhibitors, refined stent platforms, and shorter dual antiplatelet therapy (DAPT) regimens have collectively shifted the field towards strategies that minimise bleeding without compromising ischaemic protection.12 P2Y12 inhibitor monotherapy after a shorter period of DAPT is increasingly supported by trial data. Yet, when aspirin should be withdrawn – or whether it should be given beyond the loading dose at all – remains unsettled in STEMI.

In this issue of EuroIntervention, Yosofi and colleagues report the one-year outcomes of STOP-IMH,3 a multicentre open-label pilot randomised trial designed to compare ticagrelor plus aspirin as a DAPT strategy versus ticagrelor monotherapy after primary PCI for STEMI.

STOP-IMH enrolled 200 STEMI patients across five Dutch centres after successful primary PCI with drug-eluting stent implantation. All patients received aspirin and ticagrelor loading doses before PCI; they were then randomised to either ticagrelor monotherapy (n=99) or ticagrelor plus aspirin (n=101) and followed for 13 months. A...