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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Four-Year Outcomes Following Resolute Zotarolimus-Eluting Stent Implantation: RESOLUTE US Study David Lee 1, Alan Yeung 1, Martin Leon 2, Laura Mauri 3 on behalf of the RESOLUTE US Investigators 1 Stanford University School of Medicine, Stanford, CA; 2 Columbia University College of Physicians and Surgeons and Cardiovascular Research Foundation, New York, NY; 3 Brigham and Women’s Hospital and Harvard Medical School, Boston, MA ACC 2014
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Author Disclosures Consulting Fees / Honoraria Research / Research Grants Ownership / Partnership / Principal David P. LeeMedtronic, Abbott Vascular, Boston Scientific Boston Scientific, Medtronic Alan C. YeungMedtronic, Cordis, Boston Scientific, Abbott Vascular Edwards, Boston Scientific, Medtronic Martin B. LeonAngioscore Edwards LifesciencesApica, Claret Laura MauriSt. Jude Medical, Biotronik Daiichi Sankyo, Boston Scientific, Sanofi-Aventis, Eli Lilly, Bristol Myers Squibb, Cordis, Medtronic, Abbott Vascular
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Abstract Background: New-generation drug-eluting stents (DES) such as the Resolute ® zotarolimus- eluting stent (R-ZES) have been shown to be safe and effective in the treatment of coronary artery disease. Long-term follow-up is necessary for clinicians to understand the risk to benefit ratio of these devices years after implantation. Methods: The RESOLUTE US study enrolled 1,402 patients (1,561 lesions). Patients were treated with R-ZES for de novo native coronary lesions in 1 or 2 vessels with lesion length ≤27 mm, reference vessel diameter (RVD) of 2.25–4.0 mm, and diameter stenosis ≥50% and <100%. Postprocedure dual antiplatelet therapy (DAPT) was planned for 6 months. The primary endpoint was target lesion failure (TLF; cardiac death, target vessel myocardial infarction, or clinically-driven target lesion revascularization). Follow-up is planned through 5 years. Results: The mean age of enrolled patients was 64.1 ± 10.7 years, 68% (n=958/1402) were male and 34% (n=482/1402) had diabetes. Follow-up was 96% (n=1341) at 3 years. DAPT use was 56.9% at 3 years (n=710/1248) TLF was 8.5% (n=114/1341) at 3 years. Academic Research Consortium definite or probable stent thrombosis was 0.3% (n=4/1341), with 2 events occurring between years 1 and 3. In patients with diabetes, TLF was 10.8% (50/465), and there were no stent thrombosis events. Outcomes through 4 years of follow-up will be presented at the 2014 American College of Cardiology Scientific Sessions. Conclusions: The 4-year outcomes of the RESOLUTE US study will provide clinicians with further valuable information on the long-term safety and efficacy of R-ZES.
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE US New-generation drug-eluting stents such as the Resolute ® zotarolimus-eluting stent (R-ZES) have been shown to be safe and effective in the treatment of coronary artery disease. Follow-up over several years of large and well- powered trials is critical for a reliable assessment of the long term performance of these devices. Background
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE Global Clinical Program 1 Meredith IT, et al. EuroIntervention. 2010;5:692-7. 2 Serruys PW, et al. N Engl J Med. 2010;363:136-46. 3 Silber S, et al. Lancet. 2011;377:1241-47. 4 Neumann FJ, et al. EuroIntervention. 2012;7(10):1181-8. 5 Belardi JA, et al. J Interv Cardiol. 2013;26(5):515-23. 6 Yeung AC, et al. JACC. 2011;57:1778-83. 7 Lee M, et al. Am J Cardiol. 2013;112(9):1335-41. 8 Xu B, et al. JACC Cardiovasc Interv. 2013;6(7):664-70. 9 Qiao S, et al. Am J Cardiol. 2013. doi: 10.1016/j.amjcard.2013.10.042. [Epub ahead of print] Enrollment Complete - In Follow Up RESOLUTE 1 Non-RCT First-in-Human (R=139) 5 yr RESOLUTE AC 2,3 1:1 RCT vs. Xience V ™ EES (R=1140; X=1152) 4 yr Non-RCT Observational (R=2349) 3 yr 2.25 – 4.0 mm Non-RCT vs. Hx Control (R=1402) 4 yr RESOLUTE US 6 2.5 – 3.5 mm Non-RCT (R=100) vs. Hx Control RESOLUTE Japan 3 yr RESOLUTE Asia 7 Non-RCT Observational (R=312) 1 yr RI-US Registry Post-approval study (RI≈230) enrolling Enrolling / Planning 1:1 RCT vs. Taxus ™ PES (R=200; T=200) R-China RCT 8 1 yr RESOLUTE Int 4,5 RESOLUTE Int 4,5 R-China Registry 9 Non-RCT Observational (R=1800) 1 yr R-Japan SVS 2.25 Non-RCT vs. PG (R=65) 2 yr 38 mm sub-study Non-RCT vs. PG (R=114) 1 yr RESOLUTE US 7 PROPEL Post-approval study (RI=1200) vs. Hx Control enrolling
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Hx Controls Performance Goals Resolute stent 2.25–3.5 Clinical (n=1242) 2.25–3.5 Angio/IVUS (n=100) 4.0 Angio (n=60) 38mm Clinical (n=110–175) RESOLUTE US PI: M. Leon, L. Mauri, A. Yeung Primary Endpoints: 2.25–3.5 Clinical → Target Lesion Failure at 12mo2.25–3.5 Clinical → Target Lesion Failure at 12mo 2.25–3.5 Angio/IVUS → In-Stent LLL at 8mo2.25–3.5 Angio/IVUS → In-Stent LLL at 8mo 4.0 Angio → In-Segment LLL at 8mo4.0 Angio → In-Segment LLL at 8mo 38 mm Clinical → Target Lesion Failure at 12mo38 mm Clinical → Target Lesion Failure at 12mo Drug Therapy: ASA and clopidogrel/ticlopidine ≥ 6mo (per guidelines) De Novo Native Coronary Lesion Vessel Diameter: 2.25 – 4.2 mm Lesion Length: ≤ 27 mm (≤ 35 mmlesions tx w/ 38 mm stent) (≤ 35 mm lesions tx w/ 38 mm stent) Clinical endpoints Angio/IVUS endpoints 6mo4yr3yr2yr12mo18mo8mo5yr9mo30d N = max 1577 patients Up to 135 US sites Clinical Study Design Mauri L, et al. Am Heart J. 2011;161:807-14.
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Key Inclusion Criteria Clinical evidence of ischemic coronary disease Single or double de novo lesion in native coronary artery Target lesion ≤27mm in length, diameter stenosis ≥50% <100%, and target RVD ≥2.25mm ≤4.2mm Target vessel TIMI flow ≥2 Patient is able to take DAPT for at least 6 months Treatment of up to two lesions, if the lesions are located in separate target vessels Key Exclusion Criteria Acute MI within 72 hours of index procedure Previous PCI of target vessel within 9 months pre-procedure Planned PCI of any vessel within 30 days post-procedure Hx stroke or TIA within 6 months LVEF <30% RESOLUTE US Key Eligibility Criteria Mauri L, et al. Am Heart J. 2011;161:807-14.
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE US Patient Flow Chart 2 Year Follow-up 2 Year Follow-up 4 Year Follow-up 4 Year Follow-up 1 Year Follow-up 1 Year Follow-up n = 1374 98.0% n = 1374 98.0% n = 1329 94.8% n = 1329 94.8% n = 1390 99.1% n = 1390 99.1% 3 Year Follow-up 3 Year Follow-up n = 1361 97.1% n = 1361 97.1% Patients Enrolled N = 1402 Patients Enrolled N = 1402
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE US % All Patients (2.25 mm – 4.00 mm diameter) N = 1402 Patients / 1573 Lesions Age, years (mean ± SD) 64.1±10.7 Male68.3 Diabetes mellitus 34.4 IDDM9.6 Prior PCI 32.7 Reason for revascularization: Stable angina 56.1 Unstable angina 41.9 Myocardial infarction 2.1 LAD45.9 RVD (mm) 2.6 ± 0.5 Type B2/C lesion 75.2 Two vessel treatment 10.4 Stents per patient (mean ± SD) 1.2 ± 0.5 Stent length per patient (mm) 22.4 ± 10.5 Baseline Characteristics Yeung AC, et al. J Am Coll Cardiol. 2011;57:1778-83.
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Time After Initial Procedure (years) 0234 0 Cumulative Incidence of TLF (%) 10 20 30 RESOLUTE US 9.98% No. at risk 14021384130212331183 % CI 1.284.687.278.349.98 R-US All Patients (N = 1402) Target Lesion Failure to 4 Years 1
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 R-US All Patients (n=1329/1402) TLR Cardiac Death TV-MI ST (ARC Def/Prob) TLF Target lesion failure (TLF) is defined as cardiac death, target vessel MI and TLR. TLR is ischemia driven. Events (%) RESOLUTE US Safety and Efficacy Outcomes at 4 Years
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE US % n = 1329 Death (all) 7.0 Cardiac2.9 MI (target vessel) 2.6 Q Wave 0.4 Non Q wave 2.2 Cardiac death + target vessel MI 5.1 ST ARC Def/Prob (all) 0.4 Early (0-30 days) 0.1 Late (31-360 days) 0.1 Very late (>360 days) 0.2 TLR5.3 TVR10.7 TLF (cardiac death, TV-MI, TLR) 10.1 TVF14.7 Clinical Outcomes at 4 Years
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE US, AC, INT Adherence to DAPT (%) Time After Initial Procedure (months) DAPT to 4 Years 95.997.4 93.8 65.7 93.8 93.1 84.1 18.6 95.897.3 91.1 43.9 R-US (N=1402) R-All Comers (N=1140) R-International (N=2349) 13.8% 34.6% 51.4% 55.4 12.8 RESOLUTE All-Comers and International trials had very broad eligibility criteria and included approximately 67% complex patients. R-International trial completed follow-up at 3 yrs.
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 Time After Initial Procedure (years) 0234 0 1 3 5 1 RESOLUTE US Def/Prob Stent Thrombosis to 4 Years 0.38% Cumulative Incidence of ARC Def/Prob Stent Thrombosis (%) 2 4 No. at risk 14021402135513081262 % CI 0.000.140.220.290.38 R-US All Patients (N = 1402)
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For OMA distribution only. © 2014 Medtronic, Inc. All rights reserved. 10137474DOC_1A 03/14 RESOLUTE US Event rates remained very low out to 4 years:Event rates remained very low out to 4 years: –The rate of TLF (primary endpoint) was 10% –The incidence of ARC definite or probable stent thrombosis was 0.4% Similar to other US trials, adherence to DAPT after 12 months remained relatively high with 51% still taking DAPT 4 years after implantation.Similar to other US trials, adherence to DAPT after 12 months remained relatively high with 51% still taking DAPT 4 years after implantation. These late results from the RESOLUTE US study demonstrated excellent efficacy and safety and support the long term performance of the Resolute stent.These late results from the RESOLUTE US study demonstrated excellent efficacy and safety and support the long term performance of the Resolute stent. Conclusions
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