The PLATO (Platelet Inhibition and Patient Outcomes) study compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) with clopidogrel (300- or 600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovas- cular events in 18624 patients with ACS, of whom 35% had Among the 7544 patients enrolled with ST eleva- tion or LBBB who underwent primary PCI, findings were consistent with the overall trial results. Significant reductions favoring ticagrelor were seen in the primary PCI subgroup for stent thrombosis and total deaths, though there were more strokes and episodes of ICH with ticagrelor.261 A prespecified subgroup analysis in the PLATO trial showed a significant interaction between treatment effect and geographic region, with an apparently smaller ticagrelor effect in North America than in other areas. Although this interaction could have been due to chance alone,295 a contribution from higher aspirin doses, as more commonly used in the United States, cannot be excluded. When provided long term with ticagrelor as a component of DAPT, the dose of aspirin should not exceed Although 1 year of DAPT is recommended after stent implantation during primary PCI for STEMI, earlier discon- tinuation of a P2Y12 inhibitor may be necessary if the risk of morbidity from bleeding outweighs the anticipated benefit of DAPT. Clinical judgment is required, and discussion with the interventional cardiologist is recommended. 