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We hypothesized that ticagrelor monotherapy might be enough to prevent thromboembolic events without aspirin after PCI in patients with acute coronary syndrome(ACS). Moreover, ticagrelor monotherapy will reduce bleeding risk compared to DAPT with aspirin plus ticagrelor. We will also evaluate 1-year safety and efficacy of Orsiro stent for patient with acute coronary syndrome. After confirmation of enrollment, patients will be randomized to continue standard treatment (aspirin plus ticagrelor) for 1 year or to stop aspirin after discharge or less than 1 month after PCI (ticagrelor monotherapy). Randomization will be stratified according to 1) the presence of diabetes and 2) ST elevation myocardial infarction (MI). Baseline clinical and angiographic characteristics, laboratory findings will be assessed at the time of randomization. All patients will provide informed consent on their own initiative.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard DAPT | Active Comparator | Patient will continue standard treatment (aspirin plus ticagrelor) for 1 year. Dosage of ticagrelor would be 90 mg twice a day, and 100 mg of aspirin will be prescribed once a day. |
|
| Very-short DAPT within 1 month | Experimental | Patient will stop aspirin after discharge (DAPT less than 1 months after PCI) (ticagrelor monotherapy). Dosage of ticagrelor would be 90 mg twice a day, and 100 mg of aspirin will be prescribed once a day (during hospitalization). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard DAPT | Drug | Patient will continue standard treatment (aspirin plus ticagrelor) for 1 year. Dosage of ticagrelor would be 90 mg twice a day, and 100 mg of aspirin will be prescribed once a day. |
| Measure | Description | Time Frame |
|---|---|---|
| Net clinical benefit | A composite of all-cause death, MI, stent thrombosis, stroke, major bleeding | 1 year after procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Each components of net clinical benefit | All-cause death, MI, stent thrombosis, stroke, major bleeding | 1 year after procedure |
| Cardiovascular mortality | Cardiovascular mortality |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Myeong-Ki Hong, MD, PhD | Contact | 82-2-2228-8458 | mkhong61@yuhs.ac |
| Name | Affiliation | Role |
|---|---|---|
| Myeong-Ki Hong | Division of Cardiology, Severance Hospital, Yonsei University College of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine | Recruiting | Seoul | 03722 | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41697655 | Derived | Lee JH, Lee J, Kim SY, Jeon HS, Lee JW, Ahn SG, Lee YJ, Lee SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Hong SJ, Youn YJ. Optimal timing of aspirin discontinuation with ticagrelor monotherapy in acute coronary syndrome: a post hoc comparative analysis from the TICO and T-PASS trials. EuroIntervention. 2026 Feb 16;22(4):232-242. doi: 10.4244/EIJ-D-25-00832. | |
| 37878786 |
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| Very-short DAPT less than 1 month after PCI | Drug | Patient will stop aspirin (ticagrelor monotherapy) after discharge or within 1 month. Dosage of ticagrelor would be 90 mg twice a day, and 100 mg of aspirin will be prescribed once a day (during hospitalization). |
|
| 1 year after procedure |
| Major or minor bleeding | Major or minor bleeding | 1 year after procedure |
| Major adverse cardiac event | A composite of cardiac death, MI, stent thrombosis, ischemia-driven target-vessel revascularization | 1 year after procedure |
| Derived |
| Hong SJ, Lee SJ, Suh Y, Yun KH, Kang TS, Shin S, Kwon SW, Lee JW, Cho DK, Park JK, Bae JW, Kang WC, Kim S, Lee YJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK; T-PASS (Ticagrelor Monotherapy in Patients Treated With New-Generation Drug-Eluting Stents for Acute Coronary Syndrome) Investigators. Stopping Aspirin Within 1 Month After Stenting for Ticagrelor Monotherapy in Acute Coronary Syndrome: The T-PASS Randomized Noninferiority Trial. Circulation. 2024 Feb 20;149(8):562-573. doi: 10.1161/CIRCULATIONAHA.123.066943. Epub 2023 Oct 25. |
| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| D054058 | Acute Coronary Syndrome |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D001161 | Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
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