LEADERS FREE IV (RCT): BioFreedom™ Ultra vs BioFreedom™ in HBR Patients

Inclusion Criteria:

1. Patients at high bleeding risk (HBR) with an indication for PCI who can tolerate atleast one month of DAPT. This includes patients with stable angina, silent ischemia,acute coronary syndromes (ACS) (STEMI and NSTEMI), de novo lesions in nativearteries with diameter stenosis >70% by visual estimation and evidence of ischemiain the territory of the target vessel(s).

2. Patients meet ARC-HBR definition i.e at least 1 major or 2 minor criteria.

Exclusion Criteria:

1. Pregnant and breastfeeding women

2. Age <18 years old

3. Patients lacking capacity (i.e. patients suffering from dementia and others) toprovide informed consent

4. Patients expected not to comply with 1 month DAPT

5. Active bleeding at the time of inclusion

6. Procedure requires the use of non-study stents, or alternative therapeutic optionsnot followed by stent implantation (angioplasty only, atherectomy only)

7. Number of target lesions >2

8. Patient requires a stent of diameter <2.25mm

9. Patient requires a stent of diameter >4.0mm

10. Isolated ostial lesions within 3 mm of the origin of LAD or LCx (left main lesionsinvolving the ostia of the LAD and/or LCx are eligible)

11. Patient has known left ventricular ejection fraction (LVEF) <30% (LVEF may beobtained at the time of the index procedure if the value is unknown and theinvestigator believes it is necessary)

12. Patient with chronic total occlusion(s) as target lesion(s)

13. Severe calcification that might prevent sufficient expansion of the DES, unlesspre-treated with a plaque modification device such as cutting balloon, scoringballoon or intravascular lithotripsy. Note: Use of rotational or orbital atherectomy is also permitted.

14. Cardiogenic shock

15. Compliance with long-term single anti-platelet therapy unlikely

16. Known hypersensitivity or contraindication to aspirin, clopidogrel (or to any otherP2Y12 inhibitor if applicable), cobalt chromium, stainless steel, zinc, Biolimus A9™or a sensitivity to contrast media, which cannot be adequately pre-medicated

17. Any PCI during the previous 12 months

18. Participation in another clinical study (12 months after index procedure)

19. Patients with a life expectancy of <12 months