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CompletedNCT04753749TARGET-FIRSTUpdated Jul 29, 2025

Evaluation of a Modified Anti-Platelet Therapy Associated With Low-dose DES Firehawk in Acute Myocardial Infarction Patients Treated With Complete Revascularization Strategy

An interventional study of Shortened DAPT followed by P2Y12 inhibitor monotherapy (cessation of aspirin) and Standard DAPT in Myocardial Infarction, Acute and Coronary Artery Disease, sponsored by MicroPort CRM. Completed at 40 sites in 6 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-07-29.

Sponsored by MicroPort CRM · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
2,248
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The study aims to evaluate a modified antiplatelet therapy associated with Firehawk low-dose rapamycin DES in acute myocardial infarction patients treated with complete revascularization strategy. The modified antiplatelet therapy consists of a reduced duration of Dual Antiplatelet Therapy post procedure (ie. 1 month duration) followed by P2Y12 inhibitor monotherapy for the next 11 months. It is hypothesized that in the setting of clinically stable, low to moderate complexity acute Myocardial Infarction patients, a modern approach combining a stent with high biocompatibility feature, complete revascularization strategy and modified antiplatelet therapy may be associated with similar outcomes, or even a significant benefit compared with guidelines-recommended 12-month DAPT. This benefit could be driven by a reduced risk in significant bleeding events, while keeping a comparable protection against ischemic risk. Enrolled subjects will be randomized in a 1:1 ratio to either cessation of aspirin at 1 months, either continuation of DAPT. Selection of the P2Y12 inhibitor agent is left to investigator judgment but has to be in line with the current ESC guidelines. Subjects treated with the Firehawk or Firehawk Liberty coronary stent will be included in this study.

02

Conditions studied

  • Myocardial Infarction, Acute
  • Coronary Artery Disease
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Inclusion Criteria (General):

  • Troponin-positive Non-ST-Elevation MI, requiring early invasive treatment (PCI), or ST-Elevation MI requiring primary PCI, and PCI occurred within the last 7 days
  • Subject is eligible for per-protocol antiplatelet treatments
  • Written informed consent

Inclusion Criteria (Procedural/angiographic):

  • Successful revascularization
  • All treated lesions:

    • In native coronary arteries only
    • In vessels with visual reference diameter ≥2.25 mm and ≤ 4.00 mm
    • Implanted with the study device
    • Maximum 3 lesions treated (*)
    • Maximum total stent length ≤ 80 mm
  • Complete revascularization performed when more than 1 significant lesion, during the index procedure or in staged procedure(s) occurring within 7 days from the index procedure.

Exclusion Criteria (General):

  • Subjects with prior STEMI or prior PCI within 12 months before index admission
  • Prior Coronary Artery Bypass Graft (CABG) Surgery
  • Cardiogenic shock
  • Secondary PCI
  • Fibrinolysis
  • Prior stent thrombosis
  • Planned PCI, CABG, or surgery within 12 months
  • Need for Oral Anti-Coagulation therapy
  • Ischemic stroke or ICH within 12 months
  • eGFR \<30 mL/min/1.73 m2 or dialysis
  • Active bleeding at time of inclusion or high risk for major bleeding
  • History of bleeding diathesis or coagulopathy or subject refuse blood transfusions
  • Stage B or C liver cirrhosis or active cancer within 12 months
  • Baseline haemoglobin \<13 g/dL (12g/dL for women) or anaemia requiring transfusion in the 4 weeks prior to index procedure
  • Moderate or severe thrombocytopenia
  • Expected non-adherence to protocol or estimated life expectancy ≤12 months
  • Known hypersensitivity or contraindication to any medication used in the study or any of the study stent's components/compounds
  • Participation in another interventional clinical trial
  • Woman who is pregnant, nursing or with known intention to procreate

Exclusion Criteria (Procedural/Angiographic):

  • In-stent restenosis or thrombosis
  • Chronic total occlusion
  • Severe calcification
  • True bifurcation disease and side branch diameter ≥ 2mm, or bifurcation treated with 2 stents
  • Left main coronary artery lesion
  • Residual untreated dissection ≥ C
  • Implantation of a non-study stent
  • Subject is deemed to receive preferentially CABG within 1 year
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
2,248 participants (actual)

Study arms

  • Experimental
    Shortened DAPT followed by P2Y12 inhibitor monotherapy

    Drug: Shortened DAPT followed by P2Y12 inhibitor monotherapy (cessation of aspirin)

  • Active comparator
    Dual Antiplatelet Therapy

    Drug: Standard DAPT

Interventions

  • DrugShortened DAPT followed by P2Y12 inhibitor monotherapy (cessation of aspirin)

    Subjects will receive DAPT during 1 month post procedure, followed by P2Y12 inhibitor monotherapy (cessation of aspirin) for the next 11 months

  • DrugStandard DAPT

    Subjects will receive standard treatment: P2Y12 inhibitor and aspirin (DAPT) during 12 months after procedure

05

What researchers measure

Primary outcomes

  1. Net Adverse Clinical and Cerebral Events (NACCE)

    (Number of participants with first occurrence of) NACCE, defined as a composite of all cause death, non-fatal myocardial infarction, definite/probable stent thrombosis, stroke, or bleeding events (BARC type 3 or 5)

    Time frame: 11 months post randomization

Secondary outcomes

  1. Bleeding events

    (Number of participants with first occurrence of) bleeding events (BARC 2,3 or 5)

    Time frame: 11 months post randomization

  2. All-cause death, non-fatal myocardial infarction, definite/probable stent thrombosis, or stroke

    (Number of participants with first occurrence of) all-cause death, non-fatal myocardial infarction, definite/probable stent thrombosis, or stroke

    Time frame: At 1 month, 6 months and 12 months

  3. Primary endpoint component 5 - BARC 3 and 5 bleeding events

    (Number of participants with first occurrence of) BARC 3 and 5 bleeding events

    Time frame: At 1 month, 6 months and 12 months

  4. All-cause death or non-fatal myocardial infarction

    (Number of patients with first occurrence of) all-cause death or non-fatal myocardial infarction

    Time frame: At 1 month, 6 months and 12 months

  5. Major Adverse Cardiac and Cerebral Events (MACCE) - Patient

    Patient-oriented composite of major adverse cardiac and cerebral events (MACCE) including all-cause death, myocardial infarction, definite/probable stent thrombosis, any stroke, any Ischemia driven repeat revascularization, or BARC bleeding events (type 2, 3, or 5)

    Time frame: At 1 month, 6 months and 12 months

  6. Target Lesion Failure - Device

    Device oriented composite endpoint of Target Lesion Failure (cardiac death, target vessel related myocardial infarction, target lesion Ischemia Driven-revascularization)

    Time frame: At 1 month, 6 months and 12 months

  7. Major Adverse Cardiac and Cerebral events (MACE) - Events

    Number of Major Adverse Cardiac and Cerebral events (MACE)

    Time frame: At 1 Month, 6 months and 12 months

  8. Primary endpoint component 3 - Stent thrombosis

    Definite or probable stent thrombosis

    Time frame: At 1 months, 6 months and 12 months

  9. Main secondary endpoint component 2 - BARC 3 events

    (Number of patients with occurrence of) BARC 3 events

    Time frame: At 1 month, 6 months and 12 months

  10. Main secondary endpoint component 3 - BARC 5 events

    (Number of patients with occurrence of) BARC 5 events

    Time frame: At 1 month, 6 months and 12 months

  11. Main secondary endpoint component 1 - BARC 2 events

    (Number of patients with occurrence of) BARC 2 events

    Time frame: At 1 month, 6 months and 12 months

  12. Cardiovascular death

    Number of patients with cardiovascular death

    Time frame: At 1 months, 6 months and 12 months

  13. Cardiac death

    Number of patients with cardiac death

    Time frame: At 1 month, 6 months and 12 months

  14. Non cardiac death

    Number of patients with non cardiac death

    Time frame: At 1 month, 6 months and 12 months

  15. Primary endpoint component 2 - Myocardial infarction

    Number of patients with myocardial infarction

    Time frame: At 1 month, 6 months and 12 months

  16. Cardiac death or non-fatal myocardial infarction

    (Number of patients with first occurrence of) cardiac death or non-fatal myocardial infarction

    Time frame: At 1 month, 6 months and 12 months

  17. Cardiac death, myocardial infarction, or definite/probable stent thrombosis

    (Number of patients with first occurrence of) cardiac death, myocardial infarction, or definite/probable stent thrombosis

    Time frame: At 1 month, 6 months and 12 months

  18. Cardiovascular death, myocardial infarction, definite/probable stent thrombosis, or ischemic stroke

    (Number of patients with first occurrence of) cardiovascular death, myocardial infarction, definite/probable stent thrombosis, or ischemic stroke

    Time frame: 1 month, 6 months and 12 months

  19. Primary endpoint component 4 - Ischemic stroke

    (Number of patients with occurrence of) ischemic stroke

    Time frame: At 1 month, 6 months and 12 months

  20. Haemorrhagic stroke

    (Number of patients with occurrence of) haemorrhagic stroke

    Time frame: At 1 month, 6 months and 12 months

  21. Ischemia-driven target lesion revascularization

    (Number of patients with) Ischemia-driven target lesion revascularization

    Time frame: At 1 month, 6 months and 12 months

  22. Ischemia-driven target vessel revascularization

    (Number of patients with) Ischemia-driven target vessel revascularization

    Time frame: At 1 month, 6 months and 12 months

  23. Cardiovascular death, myocardial infarction, or ischemic stroke

    (Number of patients with first occurrence of) cardiovascular death, myocardial infarction, or ischemic stroke

    Time frame: At 1 month, 6 months and 12 months

  24. Primary endpoint component 1 - All cause death

    (Number of patients with) all cause death

    Time frame: At 1 month, 6 months and 12 months

  25. Primary endpoint component 2 - Myocardial infarction

    (Number of patients with occurrence of) myocardial infarction

    Time frame: At 1 month, 6 months and 12 months

06

Study locations

40 sites
  • Universitätsklinikum
    Sankt Pölten, Austria
  • CHU Annecy
    Annecy, France
  • Clinique Roseraie
    Aubervilliers, France
  • CH Bastia
    Bastia, France
  • CHU Caen
    Caen, France
  • CH Chartres
    Chartres, France
  • CH Cherbourg
    Cherbourg, France
  • CHU Clermont-Ferrand
    Clermont-Ferrand, France
  • CHU Dijon
    Dijon, France
  • CH Haguenau
    Haguenau, France
  • CHU Lille
    Lille, France
  • CH St Joseph/St Luc
    Lyon, France
  • CHU La Timone
    Marseille, France
  • Hôpital Jacques Cartier
    Massy, France
  • CHU Montpellier
    Montpellier, France
  • Clinique Millénaire
    Montpellier, France
  • CHU Nîmes
    Nîmes, France
  • CHU Reims
    Reims, France
  • Clinique St Hilaire
    Rouen, France
  • CHU Toulouse
    Toulouse, France
  • Clinique Pasteur
    Toulouse, France
  • Humanitas - Gavazzeni
    Bergamo, Italy
  • Clinica Montevergine
    Mercogliano, Italy
  • Niguarda
    Milan, Italy
  • AOU Federico II
    Naples, Italy
  • Policlinico Universitario
    Padova, Italy
  • Giovanni Paolo II
    Ragusa, Italy
  • Jeroen Bosch Ziekenhuis
    's-Hertogenbosch, Netherlands
  • Tergooi MC
    Blaricum, Netherlands
  • Albert Schweitzer Ziekenhuis
    Dordrecht, Netherlands
  • Maastad University Hospital
    Rotterdam, Netherlands
  • Haga Ziekenhuis
    The Hague, Netherlands
  • Hospital Santa Maria
    Lisbon, Portugal
  • Hospital General Universitario
    Alicante, Spain
  • Clinic Hospital Barcelona
    Barcelona, Spain
  • Hospital del Mar
    Barcelona, Spain
  • Puerta del mar
    Cadiz, Spain
  • Hospital Universitario de Bellvitge
    L'Hospitalet de Llobregat, Spain
  • Hosp. Doctor Lucus Augusti
    Lugo, Spain
  • Hospital Universitario La Princesa
    Madrid, Spain
07

References and documents

Publications

  • Tarantini G, Smits PC, Lhermusier T, Honton B, Range G, Piot C, Lemesle G, Ruiz Nodar JM, Godin M, Madera Cambero M, Motreff P, Cuisset T, Bouchez D, Poezevara Y, Cayla G. A prospective study comparing short versus standard dual antiplatelet therapy in patients with acute myocardial infarction: design and rationale of the TARGET-FIRST trial. EuroIntervention. 2023 Jun 19;19(3):240-247. doi: 10.4244/EIJ-D-22-01006. PubMed 36999409 ↗
  • Tarantini G, Honton B, Paradies V, Lemesle G, Range G, Godin M, Mangin L, Cuisset T, Ruiz-Nodar JM, Brugaletta S, Lhermusier T, Piot C, De Poli F, Macia JC, Motreff P, Madera-Cambero M, Beygui F, Riccini P, Ranc S, Oreglia JA, Vaquerizo B, Poezevara Y, Bouchez D, Smits PC, Cayla G; TARGET-FIRST Investigators. Early Discontinuation of Aspirin after PCI in Low-Risk Acute Myocardial Infarction. N Engl J Med. 2025 Nov 27;393(21):2083-2094. doi: 10.1056/NEJMoa2508808. Epub 2025 Aug 31. PubMed 40888726 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT04753749
Lead sponsor
MicroPort CRM
Collaborators
European Cardiovascular Research Center
Responsible party
Sponsor
First posted
Feb 15, 2021
Start date
Mar 25, 2021
Primary completion
May 5, 2025
Completion
May 5, 2025
Last update
Jul 29, 2025

Study contacts

Giuseppe Tarantini, Pr
principal investigator · Padova University Hospital, Italy
Cayla Guillaume, Pr
study director · Nîmes University Hospital, France
Smits Peter, Pr
study director · Maastad University Hospital, Netherlands

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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