Prasugrel vs Ticagrelor and 1–3 months vs 12 months of DAPT after MI treated with PCI
Official title: Strategies for Antiplatelet Management Following Acute Coronary Syndrome
Run by Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz · NCT07507500 · Data updated 2026-11-12
This trial tests whether a shorter duration of dual antiplatelet therapy plus one drug is as safe and effective as a full 12 months of therapy, and whether prasugrel or ticagrelor works better after a heart attack treated with PCI.
Quick facts
| Phase | Phase 4 |
|---|---|
| Study type | Interventional |
| Ages | 18 Years and up |
| Sex | All |
| Enrollment | 8100 (estimated) |
| Sponsor | Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz Academic / other |
| Locations | 5 sites (Dublin and 4 other locations) |
| Status | Recruiting |
| Started | September 2, 2026 |
| Main results expected | July 2029 |
| Study ends | January 2030 |
| Registry record updated | September 9, 2026 |
| Trial ID | NCT07507500 on ClinicalTrials.gov |
Is this trial a fit for you?
✓Likely a good fit
Adults 18 years or older who had an acute MI and underwent successful PCI and can provide informed consent.
✕Probably not a fit
Patients with contraindications to aspirin, prasugrel, or ticagrelor, active bleeding, or certain high-bleeding or hepatic conditions may not benefit.
A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.
What this trial studies
STREAMLINE is a multinational trial comparing two main questions in patients who had an acute myocardial infarction and successful PCI. It uses a 2×2 factorial design to test abbreviated DAPT (1–3 months) followed by single-drug therapy versus standard 12 months of DAPT, and to compare prasugrel with ticagrelor. The study aims to determine which strategy best reduces death, MI, or stroke while limiting major bleeding. It is pragmatic, open-label with blinded endpoint adjudication, enrolling about 8,100 participants across multiple European sites. No new drugs are being tested; the trial compares approved therapies and durations.
Why it matters
Potential benefit: If successful, this trial could identify a safer, equally effective DAPT strategy that reduces bleeding risk without increasing ischemic events.
How similar studies have gone: Previous studies have explored shorter vs longer DAPT and have shown mixed results; this trial adds contemporary, head-to-head drug comparisons in a real-world setting.
Who can join: the full rules
Show full inclusion / exclusion criteria
Inclusion Criteria: * ≥18 years old * Admitted because of an acute MI (either STEMI or NSTEMI). * Invasive management during index admission with successful PCI. * Able to consent. Exclusion Criteria: * Indication for oral anticoagulation therapy. * Intolerance, contraindication or known allergy to either aspirin, prasugrel or ticagrelor. * Prior history of ischaemic or haemorrhagic stroke or transient ischaemic attack. * Patients with active bleeding or known bleeding disorders. * Patients with known moderate or severe hepatic dysfunction (Child-Pugh Class B or Class C). * Known intracranial aneurism, arteriovenous malformation or neoplasm. * Patients with chronic kidney disease requiring dialysis. * Any disorder that may interfere with drug absorption. * Pregnancy or current lactation. * Concomitant use of potent CYP3A inhibitors or inducers. * Planned elective surgery that cannot be deferred 12 months before randomization, requiring interruption of antiplatelet therapy. * Any medical condition that, in the investigator´s judgment, would seriously limit life expectancy (less than one year) * Active participation in other clinical trials.
Where it's running
-
Fundación Jiménez Díaz University Hospital
Madrid, Spain Recruiting -
Mater Private Network Dublin
Dublin, Ireland Not yet recruiting -
Paula Stradiņa klīniskā universitates slimnīca
Riga, Latvia Not yet recruiting -
Oslo University Hospital, Ullevål.
Oslo, Norway Not yet recruiting -
Saint John Paul II Hospital in Cracow
Krakow, Poland Not yet recruiting
Study contacts
- Principal investigator: Borja Ibanez, MD PhD — Centro Nacional de Investigaciones Cardiovasculares (CNIC) & Fundacion Jimenez Díaz University Hospital (IIS-FJD)
- Study coordinator: Noemi Escalera, PT
- Email: noemi.escalera@cnic.es
- Phone: +34 91 4531200 (ext 5401)
Similar studies
Other studies for the same condition or treatment. Recruiting studies are listed first.
-
Risk of malignant arrhythmias after acute coronary syndrome
This study tracks how often dangerous heart rhythms occur in adults admitted for ACS and looks for patterns that might predict them.
-
Smartphone AI help for prehospital ECG readings
This study tests whether using a smartphone AI (GPT-4o) to help prehospital providers read 12-lead ECGs improves accuracy in diagnosing acute coronary syndromes and related conditions.
-
Optimal timing of staged complete revascularization in STEMI with multivessel disease
This trial tests whether performing staged complete revascularization during the hospital stay or after discharge is best for STEMI patients with multivessel disease.
-
BEAT-SHOCK: Baseline Registry for Acute Cardiogenic Shock at Basel
This registry collects and shares data on adults with cardiogenic shock admitted to University Hospital Basel to help understand how these patients are treated and how they fare.
-
Low-dose IL-2 after heart attack to study tissue-resident regulatory T cells
Researchers are testing whether low-dose interleukin-2 given after a myocardial infarction can boost tissue-resident regulatory T cells to support heart repair.
-
Abbreviated antithrombotic therapy after PCI in AF and MI
This trial tests whether DOAC-only therapy works as well as DOAC plus clopidogrel after PCI in people with atrial fibrillation and a recent heart attack.
How to take part
- Review the eligibility criteria above with your treating physician.
- Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
- Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.