2006 CRUSADE 2nd Quarter Results

CRUSADE Site Distribution Active sites = 400 WA (5) VT (1) ME (0) MT (0) ND (1) MI NH (1) MN (3) OR (6) NY (31) MA (10) SD (2) WI (7) ID (0) MI (21) RI (1) WY (0) PA (38) CT (7) IA (6) NJ (12) NE (2) OH (38) DE (3) NV (3) IL (20) IN (8) WV (2) UT (1) VA (17) MD (13) CO (9) KS (3) MO (9) KY (8) DC (1) CA (33) NC (14) TN (9) OK (5) SC (5) AZ (8) AR (2) NM (1) AL (8) GA (10) MS (6) LA (6) TX (16) FL (29) AK (0) HI (0) Last updated: 8/1/06

CRUSADE Cumulative Data Submission (n= 180,842)

Baseline Characteristics: CRUSADE vs. ACS Clinical Trials Variable PURSUIT CURE SYNERGY CRUSADE (n = 9461) (n = 12,562) (n = 9975) (n = 180,842) Mean age ± SD (yrs) 63 ± 11 63 ± 12 67 ± 11 67 ± 14 Female sex (%) 36 39 34 40 Diabetes mellitus (%) 23 23 29 33 Prior MI (%) 32 25 28 30 Prior CHF (%) 11 8 9 18 Prior PCI (%) 13 18* 20 21 Prior CABG (%) 12 18* 17 19 ST depression (%) 50 42 55 34 Update to end of 4th quarter CRUSADE data. NEJM 1998;339:436-43 NEJM 2001;345:494-502 JAMA 2004:292:45-54 CRUSADE cumulative through June 30, 2006

Hospital Presentation Characteristics in CRUSADE – Q2 2006 Qualifying Criteria ST-segment depression 27% Transient ST-segment elevation 4% Positive cardiac markers 93% Baseline cardiac markers Drawn Positive* CK-MB 82% 73% TnT/TnI 99% 85% Presenting Characteristics Tachycardia 21% Hypotension 4% Signs of CHF 22% *Of subset drawn Q2 2006 CRUSADE data (n=6923)

Hospital Presentation Characteristics in CRUSADE- Last 12 Months Qualifying Criteria ST-segment depression 28% Transient ST-segment elevation 5% Positive cardiac markers 93% Baseline cardiac markers Drawn Positive CK-MB 82% 75% TnT/TnI 99% 91% Presenting Characteristics Tachycardia 22% Hypotension 4% Signs of CHF 23% CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

CRUSADE In-Hospital Outcomes : Last 12 Months Death 3.9% (Re)-Infarction 1.8% CHF 7.0% Cardiogenic Shock 2.2% Stroke 0.6% RBC Transfusion* 9.4% *Excluding CABG-related transfusions CRUSADE DATA: July 1, 2005 – June 30, 2006 (n= 31,665)

CRUSADE vs. ACS Clinical Trials: Early Mortality Rates In-hospital mortality rate 4.5% 7-day mortality rate 1.9% 1.8% 1.5% PURSUIT1 (n = 9,461) PRISM-PLUS2 (n = 1,915) SYNERGY3 (n = 9,975) CRUSADE (n = 180,842) 1.The PURSUIT Trial Investigators. N Engl J Med 1998 2.The PRISM-PLUS Study Investigators. N Engl J Med 1998 3. The Synergy Study JAMA 2004 CRUSADE cumulative data through 6/30/2006

Goal for CRUSADE: Improve Adherence to ACC/AHA Guidelines Acute Therapy Discharge Therapy Aspirin Clopidogrel Beta Blocker Heparin (UFH or LMWH) GP IIb-IIIa Inhibitor Cath/PCI Aspirin Clopidogrel Beta Blocker ACE Inhibitor Statin/Lipid Lowering Smoking Cessation Cardiac Rehabilitation 2002 ACC/AHA Guidelines Update

Acute Medication Use – Q2 2006 (Within 1st 24 hours in patients without contraindications) Q2 2006 CRUSADE data (n=6923)

Acute Medication Use-Last 12 Months (Within 1st 24 hours in patients without contraindications) CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Leading and Lagging Hospital Quartiles: Acute Care—1st 24 hours Peterson et al, ACC 2004 Cumulative CRUSADE data through September 2003

Acute Medication Use by Gender: Last 12 Months CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Acute Medication Use by Age: Last 12 Months CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Invasive Cardiac Procedures – Q2 2006 (Among Patients Without Contraindications to Cath) Q2 2006 CRUSADE Data (n=6923)

Invasive Cardiac Procedures – Last 12 Months (Among Patients Without Contraindications to Cath) CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Discharge Medication Use – Q2 2006 (In patients without contraindications) *LVEF < 40%, CHF, DM, HTN # Known hyperlipidemia,  TC,  LDL Q2 2006 CRUSADE data (n=6923)

Discharge Medication Use – Last 12 Months (In patients without contraindications) *LVEF < 40%, CHF, DM, HTN # Known hyperlipidemia,  TC,  LDL CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Leading and Lagging Hospitals Quartiles: Discharge Care * LVEF < 40% # Known hyperlipidemia Peterson et al, ACC 2004 Cumulative CRUSADE data through September 2003

Discharge Medication Use by Gender: Last 12 Months CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Discharge Medication Use by Age: Last 12 Months CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Discharge Care for CABG versus PCI Patients Dyke et al, AHA 2004

Discharge Interventions – Q2 2006 Q2 2006 CRUSADE data (n=6923)

Discharge Interventions- Last 12 Months CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Treatment by Renal Insufficiency Han et al, AHA 2004

Outcomes by Renal Insufficiency Han et al, AHA 2004

Trends in Acute Therapy Adherence Quarter 3, 2005 through Quarter 2, 2006

Trends in Discharge Therapy Adherence Quarter 3, 2005 through Quarter 2, 2006

Trends in Discharge Recommendations Adherence Quarter 3, 2005 through Quarter 2, 2006

Composite Adherence Trends Over Time Quarter 1, 2002 – Quarter 2, 2006

Overall Adherence Trends Over Time Quarter 1, 2002 – Quarter 2, 2006

Link Between Overall Guidelines Adherence and Mortality Peterson et al, ACC, 2004 Cumulative CRUSADE data through September 2003

Summary NSTE ACS patients treated in routine practice are at higher risk than those enrolled in clinical trials. While care better treatment gaps persist, especially in high-risk sub-groups. Continued QI efforts are needed to improve guidelines adherence and sustain evidence-based care.

CRUSADE Continues to Evolve Continued National/Regional QI Activities New Emphasis on Drug Safety Broad Dissemination of CRUSADE findings Expansion to STEMI population (Optional) Longitudinal F/U program (Optional) Further Collaborations with Professional Societies (AHA GWTG Program)