Novolimus Elution from a Biodegradable Polymer Coated Coronary Stent

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Presentation transcript:

Novolimus Elution from a Biodegradable Polymer Coated Coronary Stent EXCELLA DESyne BD Novolimus Elution from a Biodegradable Polymer Coated Coronary Stent Stefan Verheye, MD, PhD DESyne BD is CE mark approved, not available for sale in the US

I/we have no real or apparent conflicts of interest to report. Stefan Verheye, MD, PhD I/we have no real or apparent conflicts of interest to report.

Innovating Vascular Restoration Broad Product Portfolio

Novolimus: excellent performance, known safety profile Active metabolite of Sirolimus Binds to FKBP12 forming an immunosuppressive complex mTOR inhibitor Known Safety Profile Patients treated with Sirolimus orally or via DES implantation exposed to significant amount of Novolimus Potent anti-proliferative Inhibition of proliferation of hSMC IC50 = 0.5nM Sustained performance with low drug dose 5 ug/mm stent length for all product platforms Excellent clinical outcomes

A next generation Co-Cr stent platform for DESyne® BD Platform features Cobalt chromium alloy stent with low strut thickness for high flexibility and deliverability Formula XTM coating technology with ultra thin polymer matrix without a primer layer Novolimus drug dose of 5 mcg per mm of stent length DESyne BD platform Cypher Xience / Promus Resolute BioMatrix Synergy Strut Thickness (µm) Polymer Thickness (µm) Drug Load (µg) Comparison to other leading DES* *Data on file at Elixir Medical

DESyne BD leaves no polymer behind Ultra-thin conformal coating with minimal polymer load Biocompatible byproducts Sustained Novolimus release from stent, distributed uniformly in vessel Low particulates Leaves behind true metallic strut CE Mark approved

EXCELLA BD Randomized Clinical Trial This is the Bulleted List slide. To create this particular slide, click the NEW SLIDE button on your toolbar and choose the BULLETED LIST format. (Top row, second from left) The Sub-Heading and footnote will not appear when you insert a new slide. If you need either one, copy and paste it from the sample slide. If you choose not to use a Sub-Heading, let us know when you hand in your presentation for clean-up and we’ll adjust where the bullets begin on your master page. Also, be sure to insert the presentation title onto the BULLETED LIST MASTER as follows: Choose View / Master / Slide Master from your menu. Select the text at the bottom of the slide and type in a short version of your presentation title. Click the SLIDE VIEW button in the lower left hand part of your screen to return to the slide show. (Small white rectangle) RANDOMIZED (3:1), SINGLE BLIND, MULTI-CENTER CLINICAL TRIAL Co-Principal Investigators: A. Abizaid and S.Verheye Angiographic Core Lab: CRC IVUS Core Lab: Stanford University CEC/DSMB: CRC Data Management: CRC Single/Multiple De Novo Native Coronary Artery Lesions (A-B2) Vessel Diameters: 2.5-3.5 mm Stent Diameters: 2.5-3.5 mm Lesion Length: ≤24 mm Stent Lengths: 14 - 28 mm Pre-Dilatation required / Post-Dilatation at physicians discretion 7 Cobalt Alloy Stent + Bioabsorbable Polymer + Novolimus @ 5µg per mm Stent Length ENDEAVOR DES Control n= 31 Geography: Belgium, Germany and Brazil DESyne BD DES n= 115 Clinical Follow-up Angiographic/IVUS (Subset) Follow-up 30d 6mo 9mo 12mo 2-5yrs Clinical Follow-up Primary Endpoint: In-Stent Late Lumen Loss at 6 months (QCA) (non inferiority) Device and Procedure (Clinical) Success Device-oriented composite endpoint (Death, MI, or TLR) Key Secondary Endpoints: at 1, 6, 9, 12mo and 2-5 yrs Clinically driven TLR, TVR and TVF at 1, 6, 9, 12mo and 2-5 yrs Stent thrombosis rates at 1, 6, 9, 12mo and 2-5yrs ABR, LLL and % volume obstruction at 6 months Anti-Platelet Therapy for 12 months

Baseline Patient Characteristics DESyne BD (N=115 patients) Endeavor (N=31 patients) Age, years (± SD) 65.0±9.3 60.4±10* Male 63.5% 77.4% Diabetes mellitus 28.7% 25.8% Current Smoker 18.3% 29.0% Hypercholesterolemia 72.2% 80.7% Hypertension 80.9% Previous myocardial infarction 25.2% 32.3% Previous CABG 5.2% 0.0% Previous PCI 20.0% Unstable angina 10.4% 9.7% *p = 0.028; all others p=ns

Baseline Lesion Characteristics DESyne BD (N=127 lesions) Endeavor (N=38 lesions) Target Vessel Left anterior descending 43.3% 39.5% Left Circumflex 27.6% 21.1% Right coronary artery 29.1% AHA/ACC Lesion class C 16.5% Lesion Length, mm (± SD) 14.59±5.53 15.30±5.29 Reference Vessel, mm (± SD) 2.94±0.38 3.01±0.46 Ostial Lesion 3.1% 2.6% Moderate to Heavy Calcification 34.6% 36.8% Thrombus 0.8% 0% Bifurcation 7.9% 5.5% p=ns for all characteristics

Angiographic Results 6 months In-Stent Analysis DESyne BD Endeavor P value RVD. mm N(L)=119 N(L)= 38 Post-procedure 3.00±0.37 3.08±0.35 0.31 At 6-months 2.95±0.37 2.99±0.38 0.67 MLD / Late Lumen loss (LLL), (mm) Acute gain 1.87±0.42 2.01±0.43 0.09 MLD post-procedure 2.76±0.37 2.90±0.34 0.04 MLD at 6-months 2.64±0.39 2.22±0.53 <0.001 LLL at 6-months (in-stent) 0.12±0.15 0.67±0.47 < 0.001 Diameter Stenosis (%) 8.5±44 6.2±4.5 0.002 11.0±6.6 25.6±15.1 Binary Restenosis (%) (in-stent) 0.0% 7.9% 0.003 Volumetric Analysis N(L)=35 N(L)=16 %Neointimal volume obstruction (%) 3.6±4.2 20.7±14.2 < 0.001 

Zone of non-inferiority Pre-specified margin=0.20mm Primary Endpoint Analysis 6-month In-Stent Late Lumen Loss Novolimus 0.12 Zotarolimus 0.67 DELTA* (Upper 1-sided 95% CI) -0.55 (-0.44) Non-inferiority P value <0.001 Superiority *Least square means Zone of non-inferiority Pre-specified margin=0.20mm Zone of Superiority Zone of non-inferiority Zone of inferiority Superior -0.20 -0.20 -0.10 -0.10 0.30 -0.60 -0.60 -0.50 -0.50 -0.40 -0.40 -0.30 -0.30 0.00 0.00 0.10 0.10 0.20 0.40 Upper one-sided 95% CI Met Primary Non-Inferiority Endpoint and Superiority Endpoint

Clinical Results –12 months 0 to 360 days, % (n) DESyne BD (N=112)* Endeavor (N= 31) P-Value HIERARCHICAL EVENTS DEVICE-ORIENTATED COMPOSITE 2.7% 3.2% 1.00 CARDIAC DEATH 0.0% -- TARGET VESSEL MI 0.9%§ CLINICALLY-INDICATED TLR 1.8% 0.52 Definite/Probable Stent Thrombosis §2 vessel intervention with peri-procedural enzyme rise and no further complications *Modified Intention to Treat (patients who received a study stent)

Conclusions The EXCELLA BD Trial demonstrated both non-inferiority and superiority of the DESyne BD Novolimus Eluting Stent compared to the control for the primary endpoint of in-stent late lumen loss at 6 months Angiographic binary restenosis for the DESyne BD stent was significantly lower compared to the control (0.0% vs. 7.9%, p=0.003) The composite endpoint of cardiac death, TV-MI and CI-TLR remains low and unchanged from 6 months for both groups demonstrating clinical safety of the DESyne BD stent There were no reported stent thrombosis through 12 months DESyne BD is CE mark approved, not available for sale in the US