P4398Snuff-box versus distal forearm for trans-radial access: performance and radial patency

Abstract

been associated with an increased risk of restenosis and adverse events. The BIONICS trial was a large, multicenter randomized study comparing ridaforolimus-eluting stents (RES) with zotarolimus-eluting stents (ZES) in patients undergoing PCI. Enrollment of bifurcation lesions treated with a provisional 1-stent technique was allowed. Purpose: We sought to evaluate the clinical and angiographic outcomes of patients undergoing bifurcation lesion treatment in the BIONICS trial. Methods: A total of 1914 patients were randomized to treatment with RES or ZES and were included in the present analysis. Bifurcation lesions were analyzed by an angiographic core laboratory blinded to treatment assignment. Outcomes were analyzed according to the presence of a bifurcation lesion. Results: Baseline clinical characteristics were similar for patients with (n=686; 35.8%) and without (n=1228; 64.2%) bifurcation lesions. Among the 686 patients with bifurcation lesions, any side branch treatment was performed in 168 (24.4%) patients, with stent placement as bailout in 2 (0.3%) cases. Procedural success was high overall, and similar between patients with and without bifurcation lesions (96.8% vs 97.8%, p=0.18, respectively), with a trend toward more periprocedu-ral MIs in the bifurcation lesion group (3.4% vs 2.2%, p=0.13). At 1 and 2 years of follow-up, there was no difference in the rate of target lesion failure (TLF) between the bifurcation and non-bifurcation groups (5.7% vs 5.1% respectively at 1 year, p=0.44, and 7.6% vs 7.3% respectively at 2 years, p=0.81). Among 195 patients with angiographic follow-up at 13 months, the main branch in-stent diameter stenosis (%) (20.1±16.5 vs 18.9±15.3, p=0.62) and rate of binary resteno-sis (7.9% vs 8.4%, p=0.90) were also similar between the bifurcation and non-bifurcation groups, respectively. The primary endpoint of 1-year TLF was similar with ZES and RES, and consistent in patients with and without bifurcation lesions (p interaction =0.52) Conclusions: Patients with bifurcation lesions treated with a provisional 1-stent strategy presented similar clinical and angiographic outcomes as those with non-bifurcation lesions. Event-free survival was comparable with ZES and RES use in bifurcation and non-bifurcation lesions.