ENDEAVOR III Multicenter Randomized Trial Clinical/MACE Angio/IVUS

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Presentation transcript:

ENDEAVOR III Multicenter Randomized Trial Clinical/MACE Angio/IVUS 3:1 Randomization Single Blind – Single Vessel – No Staging Single De Novo Native Coronary Lesions Vessel Diameter: 2.5-3.5 mm Lesion Length: 14-27 mm Stent Lengths: 18-33 mm (8/9) mm bailout Pre-dilatation required Endeavor Stent n = 327 N = 436 patients 30 U.S. sites Cypher Stent n = 109 Clinical Endpoints 30d 6mo 4yr 3yr 2yr 9mo 12mo QCA IVUS 8mo 5yr Clinical/MACE Angio/IVUS Primary Endpoint: In-segment late lumen loss by QCA at 8 months Secondary Endpoints: TLR, TVR, TVF at 9 months & ABR at 8 months Antiplatelet therapy for ³3 months 10 g Zotarolimus per mm stent length

ENDEAVOR III Study Objectives (2003) To determine whether results of the Endeavor DES in a United States PCI population were similar to those observed in Endeavor trials conducted internationally To determine whether 8 month angiographic outcomes (in-segment late loss) with the Endeavor DES are non-inferior to the FDA-approved Cypher DES

ENDEAVOR III Outstanding Questions (2010) Does higher late loss with Endeavor ZES stent (compared with Cypher SES) translate into greater late-term TLR beyond the period of angiographic follow-up? What are the late-term safety outcomes of Endeavor ZES and Cypher SES? Are Endeavor ZES outcomes consistent with late-term follow up observed in the overall Endeavor Clinical Trial program?

ENDEAVOR III Patient Flowchart Randomized Patients Enrolled N = 436 Cypher n = 113 Randomized Angio F/U (8 mo) 277/323 85.8% Angio F/U (8 mo) 94/113 83.2% Clinical F/U (24 mo) 317/323 98.1% (12 mo) 321/323 99.4% (36 mo) 314/323 97.2% (48 mo) 310/323 96.0% (60 mo) 307/323 95.0% Clinical F/U (24 mo) 112/113 99.1% (12 mo) (36 mo) 110/113 97.3% (48 mo) (60 mo) 108/113 95.6%

ENDEAVOR III Selected Baseline Characteristics Endeavor n = 323 Cypher value Age – years (mean ± SD) 61.4 ± 10.6 61.7±11.6 0.80 Males (%) 65.3 81.4 0.001 Diabetics (%) 29.7 28.3 0.81 Unstable Angina (%) 51.1 56.1 0.41 RVD (mm) 2.75 2.79 0.49 Lesion length (mm) 15.0 0.99 B2/C lesions (%) 67.2 56.6 0.05

ENDEAVOR III Dual Antiplatelet Therapy (DAPT) Patients On DAPT At: 1 Year 2 Years 3 Years 4 Years 5 Years Endeavor 17.5 (54/308) 5.6 (17/304) 7.5 (22/293) 6.9 (20/289) 7.0 (20/286) Cypher 16.5 (18/109) 9.3 (10/108) 9.8 (10/102) 9.3 (9/97) 6.4 (6/94) Data presented as percentages.

1º Non-inferiority Endpoint Not Met ENDEAVOR III Angiographic and IVUS Results at 8 Months Endeavor n = 277 Cypher n = 94 P value BAR (%) In-Stent 9.7 2.1 0.01 In-Segment 12.3 4.3 0.03 Late Loss (mm) In-Stent 0.62 0.15 <0.001 0.36 0.13 Volume Obstruction (%) 15.9 2.7 1º Non-inferiority Endpoint Not Met

ENDEAVOR III Clinical Outcomes to 60 Months Endeavor N = 307 Cypher P value Death (all) – % (n) 5.2 (16) 13.0 (14) .015 Cardiac 0.3 (1) 2.8 (3) .056 MI (all) – % (n) 1.0 (3) 4.6 (5) .031 Q Wave 0.9 (1) .453 Non Q wave 0.7 (2) 3.7 (4) .042 Death (cardiac) + MI (all) – % (n) 1.3 (4) 6.5 (7) .009 Stent Thrombosis (def/prob) – % (n) 1.000 0-360 days 361-1800 days TLR – % (n) 8.1 (25) .678 TVR (non-TL) – % (n) 11.4 (35) 8.3 (9) .468 TVR – % (n) 16.9 (52) .363 MACE – % (n) 14.0 (43) 22.2 (24) .050 TVF – % (n) 17.9 (55) 18.5 (20) .885

ENDEAVOR III TLR, Cardiac Death/MI and MACE at 9 and 60 Months TLR Δ 6.5% vs. 15.1% Δ 1.9% vs. 3.0% Δ 0.7% vs. 3.0% 9 months 60 months

Cumulative Incidence of Time after Initial Procedure (days) ENDEAVOR III Cardiac Death/MI to 60 Months 15% £ 1 year Endeavor Cardiac Death/MI = 0.62% > 1 year through 5 years Endeavor Cardiac Death/MI = 0.67% Cypher Endeavor P = 0.003 10% Cumulative Incidence of Cardiac Death or MI 6.5% 5% 1.3% 0% 360 720 1080 1440 1800 Time after Initial Procedure (days) CD/MI 360 720 1080 1440 1800 Endeavor 323 321 314 306 298 290 Events n (CI%) 2 (0.6) 3 (1.0) 4 (1.3) Cypher 113 109 107 103 98 94 # Events n (CI%) 4 (3.5) 6 (5.5) 7 (6.5)

Cumulative Incidence of Time after Initial Procedure (days) ENDEAVOR III ARC ST Def/Prob to 60 Months 5% £ 1 year Endeavor ARC ST = 0.32% > 1 year through 5 years Endeavor ARC ST = 0.34 % Cypher Endeavor P = 0.756 4% 3% Cumulative Incidence of Def/Prob Thrombosis 2% 1% 1.0% 0.7% 0% 360 720 1080 1440 1800 Time after Initial Procedure (days) ARC ST 360 720 1080 1440 1800 Endeavor 323 315 308 300 292 Events n (CI%) 0 (0.0) 1 (0.3) 2 (0.7) Cypher 113 111 106 101 97 1 (1.0)

Cumulative Incidence from TLR Time after Initial Procedure (days) ENDEAVOR III TLR to 60 Months 35% £ 1 year Endeavor TLR = 6.6% > 1 year through 5 years Endeavor TLR = 1.4% Cypher Endeavor P = 0.547 30% 25% 20% Cumulative Incidence from TLR 15% 10% 8.0% 6.5% 5% 0% 360 720 1080 1440 1800 Time after Initial Procedure (days) TLR 360 720 1080 1440 1800 Endeavor 323 280 272 263 257 Events n (CI%) 0 (0.0) 21 (6.6) 22 (6.9) 23 (7.3) 24 (7.7) 25 (8.0) Cypher 113 107 101 97 91 4 (3.5) 5 (4.5) 7 (6.5)

Cumulative Incidence from MACE Time after Initial Procedure (days) ENDEAVOR III MACE to 60 Months 35% £ 1 year Endeavor MACE = 7.8% 1 year through 5 years Endeavor MACE = 5.8% Cypher Endeavor P = 0.054 30% 25% 21.8% 20% Cumulative Incidence from MACE 15% 13.6% 10% 5% 0% 360 720 1080 1440 1800 Time after Initial Procedure (days) MACE 360 720 1080 1440 1800 Endeavor 323 321 293 284 275 268 Events n (CI%) 2 (0.6) 25 (7.8) 29 (9.0) 35 (11.0) 39 (12.3) 43 (13.6) Cypher 113 109 103 98 94 88 4 (3.5) 9 (8.0) 13 (11.5) 16 (14.3) 21 (18.9) 24 (21.8)

ENDEAVOR III Conclusion at 5 Years In a trial designed to evaluate a primary angiographic endpoint, late lumen loss is greater with Endeavor ZES compared with the Cypher SES Despite initially higher angiographic late loss with ZES, Rates of TLR beyond period of protocol-mandated angiographic surveillance remain stable Absolute differences between DES in clinical restenosis temporally decrease over late term Recognizing limitations in sample size, late term (5y) follow up of the Endeavor stent demonstrates Durability in efficacy (TLR) Very low rate of VLST (1 event) Compared with Cypher SES, emerging differences in cardiac death/MI and MACE achieving statistical significance Late term EIII outcomes with the Endeavor ZES parallel the consistent safety and efficacy observed across the Endeavor Clinical Trials Program