Optimal antiPlatelet Therapy for High Bleeding and Ischemic RISK Patients Trial

Inclusion Criteria: * ACS patients undergoing PCI (New-Generation DES) and finishing 9-12 months of DAPT * 18 \~ 85 years old adult patients * Patients under the age of 65 must meet at least one of the following clinical criteria of high bleeding risk and at least one of the following clinical criteria of high ischemic risk; Patients aged 65-75 must meet one of the following clinical criteria of either high bleeding risk or high ischemic risk. Clinical criteria of high bleeding risk: * ≥75 years old * female * Iron deficiency anemia * history of stroke (hemorrhagic or ischemic) * ongoing medical treatment of diabetes (oral hypoglycemic agents or subcutaneous insulin) * Chronic kidney disease (eGFR \<60mL/min or creatinine clearance\<60mL/min) Clinical criteria of high ischemic risk: * ≥75 years old * Multiple coronary lesions * target lesions required for stent of total length\> 30mm * Thrombotic target lesions * Bifurcation lesions are Medina 0, 1, 1 or 1, 1, and 1, with stents implanted in both main branch and side branch * Left main coronary artery (≥50%) or proximal LAD (≥70%) lesions * Calcified plaques requiring endovascular excision * acute coronary syndrome with troponin positive * Previous myocardial infarction, ischemic stroke, diagnosed peripheral arterial disease (PAD), or revascularization due to coronary artery disease (CAD) / PAD * recurrent myocardial infarction, revascularization, stent thrombosis, stroke in the last 9 months * ongoing medical treatment of diabetes (oral hypoglycemic agents or subcutaneous insulin) * Chronic kidney disease (eGFR\<60 mL/min or creatinine clearance \<60 mL/min) Exclusion Criteria: * Discontinuation or termination of DAPT treatment during the past 6 months due to adverse events (bleeding or ischemia) or other conditions * Surgery plan within 90 days * Coronary Revascularization (Surgical or Intervention) Program within 90 days * Dialysis-dependent renal failure * Moderate or severe hepatic insufficiency (2 times the upper limit of normal for ALT or AST) * Life expectancy \<1 year * Unable or unwilling to provide informed consent * Women with childbearing potential * Platelet count \<100000/mm3 * Subjects undergoing warfarin or similar anticoagulant therapy