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Resolute in the DES era:Indications & Limitations

Georgios I. Papaioannou, MD, MPH, FACC, FSCAI

Athens Medical Center

Cardiac Catheterization Laboratory

11/6/2009

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Use of DES in Europe in 2007

83 80

65 63

5449

44

0

10

20

30

40

50

60

70

80

90

Tsech Rep Portugal Spain Gr Britain Greece France Scandinavia

DES %

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Combining Proven DES Components with Innovative Technologies

Proven Components• Driver stent offers uniform

vessel support

• Sprint delivery system offers outstanding low-profile advantage

• Potent antiproliferative drug allows effective inhibition of neointima growth

Innovative Technologies• BioLinx biocompatible polymer

allows for rapid, complete and functional healing

• Effective drug-release kinetics inhibitneointima growth

100

80

60

40

20

0% Z

ota

rolim

us

Rel

ease

0 50 100 150 200

Days

% Eluted

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RESOLUTE Single Arm First-in-Human (n=139) 2yrSingle Arm First-in-Human (n=139) 2yr

RESOLUTE Intl Non-RCT Observational (R=2,464)Non-RCT Observational (R=2,464)

RESOLUTE AC*

RESOLUTE US 2.5 – 3.5 Clinical Non-RCT vs. Hx Control (R=1,112)2.5 – 3.5 Clinical Non-RCT vs. Hx Control (R=1,112)

1:1 RCT** vs. Xience® (R=1,150,X=1,150)1:1 RCT** vs. Xience® (R=1,150,X=1,150)

2.5 – 3.5 Angio / IVUS Non-RCT vs. Hx Control (R=100)2.5 – 3.5 Angio / IVUS Non-RCT vs. Hx Control (R=100)

2.25 Angio Non-RCT (R = 129)2.25 Angio Non-RCT (R = 129)

4.0 Angio Non-RCT (R = 58)4.0 Angio Non-RCT (R = 58)

Non-RCT (R 100)Non-RCT (R 100)RESOLUTE Japan

RESOLUTE Clinical Program

38 mm+ – Long Lesion Non-RCT (R = TBD)38 mm+ – Long Lesion Non-RCT (R = TBD)

* Resolute AC: Resolute All Comers; **: RCT: Randomized Clinical Trial

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Single De Novo Native Coronary Artery LesionsLesion Length: 14-27mm

Stent Diameters: 2.5, 3.0, 3.5mmStent Lengths: 18, 24, 30mm (8/9mm bailout)

Drug Dose: 1.6 g/mm2 stent surface areaAntiplatelet therapy for 6 months

Pre-dilatation required

130 Patients (9 additional PK Sub-Study Patients enrolled after original 130 patients)12 Sites (New Zealand and Australia)

Endeavor Resolute Stent

Clinical/MACE

Angio/IVUS30d 6mo 4 yr3yr2yr9mo 12mo 5 yr

Primary Endpoint: Late lumen loss (in-stent) at 9 months by QCA

Secondary Endpoints: MACE at 30 days, 6, 9 and 12months and IVUS and

angiographic parameters at 9months

30 pt Subset: 4month MACE and angiographic, IVUS parameters

4mo

RESOLUTE

N=30 N=100

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N = 2,300 patients15 – 20 sites (100% monitored)

Western Europe

Primary Endpoint: Composite - Cardiac Death, Target Vessel MI, TLR @ 12moSecondary Endpoints: Composite @ 30d, 6mo, 2 – 5 yr; angiographic &

optical coherence tomography (OCT) parameters @ 13 moDrug Therapy: ASA and clopidogrel/ticlid 6 months (per guidelines)

30d30d 6mo6mo 4yr4yr3yr3yr2yr2yr12mo12mo 13mo13mo8mo8mo 5yr5yr

Clinical/MACE

Angio/IVUS

Resolute Stentn 1,150

Control Xience V Stentn 1,150

Real World (Open Label)All Comers with symptomatic coronary artery

disease

ClinicalEndpoints

460 (20%) QCA subset50 (2%) OCT Subset

RESOLUTE All Comers

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N = 1,399 patients125 sites

United States

Primary Endpoints:2.25 Angio In-Segment %DS @ 8 mo / Key 2EP TLF @ 12 mo2.5 – 3.5 Clinical Target Lesion Failure @ 12 mo2.5 – 3.5 Angio/IVUS In-Stent LLL @ 8 mo4.0 Angio In-Segment LLL @ 8 moDrug Therapy: ASA and clopidogrel/ticlid 6 months (per guidelines)

30d30d 6mo6mo 4yr4yr3yr3yr2yr2yr12mo12mo 13mo13mo8mo8mo 5yr5yr

Clinical/MACE

Angio/IVUS

Resolute Stent2.25 Angio (n = 129)

2.5 – 3.5 Clinical (n = 1,112)2.5 – 3.5 Angio/IVUS (n = 100)

4.0 Angio (n = 58)

Hx ControlsPerformance Goals

De NovoDe Novo Native Coronary Lesion Native Coronary LesionVessel Diameter: 2.25-4.2 mmVessel Diameter: 2.25-4.2 mm

Lesion Length: Lesion Length: 27 mm 27 mm

ClinicalEndpoints

QCA/IVUS subsets

RESOLUTE US

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N = 2,464 patients~100 sites

International

Primary Endpoint: Composite - Cardiac Death & Target Vessel MI @ 12moSecondary Endpoints: ARC Definite and Probable Stent Thrombosis @ 12 moDrug Therapy: ASA and clopidogrel/ticlid 6 months (per guidelines)

30d30d 6mo6mo 3yr3yr2yr2yr12mo12mo8mo8mo

Clinical/MACE

Angio/IVUS

Real World (Open Label)All Comers with symptomatic coronary artery

disease

ClinicalEndpoints

RESOLUTE International

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Angiographic Results9 Month Cohort9 Month Cohort

In-stent In-segmentPre-procedure RVD (mm) 2.79 ± 0.40

Lesion Length (mm) 15.87 ± 6.51 MLD (mm) pre 0.82 ± 0.35

post 2.74 ± 0.41 2.33 ± 0.44

Acute Gain 1.91 ± 0.47 1.51± 0.50 9 mo f/u MLD (mm) 2.51 ± 0.48 2.21 ± 0.45

Late Loss (mm) 0.22 ± 0.27 0.12 ± 0.27

Late Loss Index 0.12 ± 0.16 0.08 ± 0.21

9 mo f/u % DS 10.13 ± 12.63 21.08 ± 10.62

ABR n (%) 1 (1%) 2 (2.1%)

n=96

As presented at TCT 2007

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0,8

5,4

0,0

0,8 0,8

7,0

8,5

5,4

2,3

Cardiac Death

TotalMI

(n=129)

TVR MACETLR TVFNQWMI QWMIDeath

RESOLUTE

Clinical Events at 12 months

Rat

e (%

)

3/129 1/129 9/129 11/1297/129 7/129 1/129 1/129

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RESOLUTE

Dual Antiplatelet Therapy (DAPT) UsageDual Antiplatelet Therapy (DAPT) UsageDual Antiplatelet Therapy (DAPT) UsageDual Antiplatelet Therapy (DAPT) Usage

Percent of patients on DAPT at: 6 months 9 months 1 year 2 years

RESOLUTE77.7%

(101/130)

58.1%

(75/129)

55.1%

(70/127)

43.3%

(55/127)

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DES Current Questions

• “Off - label” use

• Use in ACS

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HORIZONS-AMI

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Thank you!