Early aspirin discontinuation after coronary intervention may not suit all ACS patients. The NEO-MINDSET trial, published in the Journal of the American College of Cardiology, found that withdrawing aspirin early increased ischemic events in STEMI, while appearing safe and less likely to cause bleeding in NSTE-ACS.

The multicenter trial randomized 3,410 ACS patients within four days of hospitalization to either potent P2Y12 inhibitor monotherapy or standard dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 inhibitor for 12 months. Among those with STEMI, ischemic events occurred in 8.2% of patients on monotherapy compared with 5.2% on DAPT (HR 1.60; 95% CI 1.14–2.24). In NSTE-ACS, ischemic event rates were comparable (5.1% vs 6.0%; HR 0.84; 95% CI 0.39–2.02), but bleeding decreased significantly (HR 0.45; 95% CI 0.23–0.86).

These results highlight the need for individualized antiplatelet strategies in ACS. Aspirin should be continued in STEMI, but early withdrawal may be safe for NSTE-ACS to lower bleeding risk.