‘The 15-year clinical results of the Radial Artery Patency and Clinical Outcomes randomized trial comparing radial artery to right internal thoracic artery or saphenous vein grafts.’(EURHEARTJ-D-22-03079) The standard coronary artery bypass grafting (CABG) operation uses the left internal thoracic artery to the left anterior descending artery (LITA-LAD). 1 However, the optimal graft for the second most important coronary target remains debated. 2 The Radial Artery Patency and Clinical Outcomes (RAPCO) program (NCT00475488) was designed as two separate randomized trials in which the radial artery (RA) was compared with either the right internal thoracic artery (RITA)—as a free graft—or the saphenous vein (SV), as the conduit for grafting the second most important coronary target. We herein present the 15-year clinical outcomes of the RAPCO program. Ethics approval was granted by the Austin Hospital Human Research Ethics Committee (H95/086 and H2006/02690), and all patients gave written informed consent. Patients with left ventricular ejection fraction> 35%, at least one non-LAD vessel with a proximal stenosis of at least 70% and a diameter of at least 1.5 mm, were included. Patients were randomized to receive either the RA or the RITA (RAPCO-RITA) if they were younger than 70 years, or younger than 60 years if diabetic. Patients were randomized to receive either the RA or the SV (RAPCO-SV) if older than 70 years, 60 years if diabetic. All patients received a LITA-LAD. The primary outcome for this analysis was the 15-year event rate of the composite major adverse cardiovascular events, defined as all-cause death, myocardial infarction, or repeat revascularization. Secondary outcomes included the individual component event rates of the primary composite outcome. The primary analysis was by intention-to-treat principle. In the RAPCO-RITA, there were no inter-group differences at baseline and only 1 patient was lost to follow-up. The 15-year MACE rate was 39.4% in the RA group and 48.5% in the RITA group [hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.55–0.97, P= 0.04, Figure 1A]. Kaplan–Meier estimates of mortality at 15 years were 22.2% and 30.1% in the RA and the RITA groups, respectively (log rank P= 0.06; HR 0.69, 95% CI 0.47–1.02). No differences between the RA and the RITA were found in myocardial infarction (13.1% vs. 15.3%; competing risk pseudo-HR0. 76, 95% CI0. 45–1.29, Gray–Fine’s P= 0.31), orin repeat revascularization (18.7% vs. 21.4%; competing risk pseudo-HR 0.79, 95% CI 0.51–1.23, Gray–Fine’s P= 0.30). The treatment effect for the primary outcome showed no heterogeneity in pre-specified key clinical subgroups (age, sex, and diabetes), with consistency in sensitivity analyses based on a multivariatemodeladjustedforage, sex, diabetes, andpreviousmyocardial infarction. The as-treated analysis was qualitatively consistent with the intention-to-treat analysis (HR 0.76; 95% CI 0.56–1.03). In RAPCO-SV, there were no intergroup differences at baseline and only 1 patient was lost to follow-up. The 15-year MACE rate was 60.2% in the RA group and 73.2% in the SV group (HR 0.71, 95% CI 0.52–0.98, P= 0.04; Figure 1B). Kaplan–Meier estimates of mortality at 15 years were 52.2% and 63.4% in the RA and the SV groups, respectively (log rank P= 0.08; HR 0.74, 95% CI 0.52–1.04). No differences between the RA and the SV were found in myocardial infarction (11.5% vs. 16.1%; competing risk pseudo-HR 0.59, 95% CI 0.29–1.21, Gray–Fine’s P= 0.15), and in repeat revascularization (10.6% vs. 16.1%; competing risk pseudo-HR 0.57, 95% CI 0.27–1.19, Gray–Fine’s P= 0.13). The treatment effect …