Author's summary This study demonstrated that for acute coronary syndrome patients treated with drug eluting stents, high bleeding risk (HBR) was associated with higher rates of net adverse clinical events (NACEs), not only including bleeding but also ischemic events. Ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) was associated with lower rates of NACEs and major bleeding than ticagrelor-based 12-month DAPT regardless of HBR, with no significant interaction between therapy and HBR. These findings were consistent regardless of HBR definition by Academic Research Consortium for HBR criteria or by Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT score.