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Xience V® Update Building the Future on the Foundation of Angiographic and Clinical Superiority Chuck Simonton MD, FACC, FSCAI Chief Medical Officer, Abbott Vascular CRT 2010 1
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Charles A. Simonton, MD DISCLOSURES
Chief Medical Officer Abbott Vascular Santa Clara, CA
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XIENCE V: Best-in-Class Components
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XIENCE V: Thinnest Struts of Any DES1
CYPHER TAXUS Liberté ENDEAVOR XIENCE V Strut Thickness: 140 mm Coating Thickness: 12.6 mm Strut Thickness: 97 mm Coating Thickness: 17.8 mm Strut Thickness: 91 mm Coating Thickness: 4.8 mm Strut Thickness: 81 mm Coating Thickness: 7.8 mm NEED LIBERTE picture. Total = um um um um 3.0 mm diameter stents, 500x magnification 1Manufacturer-reported strut thickness. Data on file at Abbott Vascular.
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Investment in Clinical Programs: Worldwide DES Clinical Trials
NOTE: For trials that have completed enrollment, numbers are final enrollment. For trials that are planned or still enrolling, numbers are per protocol XIENCE to be studied in ~29,000 patients Pre-Approval Post-Market Trial Name # of Enrolling Sites # of Patients Time Patients Followed Trial Name # of Enrolling Sites # of Patients Time Patients Followed SPIRIT V SPIRIT Women XIENCE V USA 2 XIENCE V India XIENCE V China XIENCE V Japan XIENCE V EXCEED FAR XIENCE V 1 XERES 1 EXECUTIVE 1 112 100 250 19 TBD 83 58 24 30 3,025 2,050 ~8,000 1,000 ~2,450 ~1,900 2,500 1,200 100 600 5 yrs 3 yrs Acute 2 yrs SPIRIT FIRST 1 SPIRIT II SPIRIT III SPIRIT III Japan SPIRIT IV SPIRIT Small Vessel SPIRIT PRIME 9 28 65 12 58 50 75 60 300 1,002 88 3,690 150 500 5 yrs 1 European Study 2 XIENCE V USA will include a DAPT subset; 5-year patient follow-up on a subset; additional subsets have 33-month or 12-month follow-up Note: This product is currently CE marked. Where CE marking is not the registration in force, this product may be in Abbott Vascular’s pipeline. For trials that have completed enrollment, numbers are final enrollment. For trials that are planned or still enrolling, numbers are per protocol 6
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SPIRIT III Trial Design & Demographics
2 : 1 XIENCE V (N = 669) TAXUS (Control = 333) Up to two de novo lesions, maximum of one lesion per epicardial vessel RVD: 2.5 – 3.75 mm LL: 28 mm N = 1,002 65 US sites PI: Gregg Stone, MD RCT: Prospective, single blind Primary end point: In-segment Late Loss at 8M Stent Size: 2.5 – 3.5 mm; Stent lengths: 8, 18, 28 mm Angiographic and IVUS Follow-Up on 564 and 240 pts, respectively Clinical follow-up at 30, 180, 270d and 1, 2, 3, 4 and 5 years 6 Months clopidogrel for all arms SPIRIT III Trial Objective To determine the safety and efficacy of the ML XIENCE V™ EECS System in patients with de novo native coronary artery lesions. SPIRIT III was the pivotal trial in the US for FDA approval. XIENCE V TAXUS P-Value Patients 669 332 NA RVD (mm)* 2.77 ±0.5 2.76 ±0.5 Lesion Length (mm)* 14.7 ±5.6 14.7 ±5.7 Diabetics 29.6% 27.9% 0.60 7 Taxus Express2 was used as the control in SPIRIT III. *SOURCE: Stone, Gregg, JAMA. Vol 299, No. 16 7
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SPIRIT III 3-Year Major Adverse Cardiac Events
XIENCE V® TAXUS® 3-year HR 2-year HR 0.57 [0.39, 0.83] 0.55 [0.37, 0.82] p=0.003 1-year HR p=0.003 0.56 [0.35, 0.90] 15.7% 13.1% p=0.01 MACE (%) ∆6.6% 9.9% ∆5.6% ∆4.2% 9.1% 7.5% XIENCE V: Delivers long term safety The difference in MACE between XIENCE V and TAXUS continues to widen between 1, 2 and 3 years with a 43% reduction in MACE at 3 years 5.7% Number at risk XIENCE V® 669 652 643 628 612 598 597 591 581 576 574 572 569 TAXUS® 332 312 308 291 286 275 272 269 266 264 260 258 255 Months 8 Taxus Express2 was used as the control in SPIRIT III. SOURCE: Gregg Stone SPIRIT III 3 Year Results TCT 2009 8
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Taxus Express2 was used as the control in SPIRIT III.
SPIRIT III 3-Year Landmark Analysis Stent Thrombosis (ARC) 0.3% VLST (ARC Definite + Probable) 0% S.T. between years 2 & 3 in 669 pts TAXUS XIENCE V 2-year HR 0.32 [0.05, 1.93] p=0.19 3-year HR 0.32 [0.05, 1.93] p=0.19 1-year HR 1.48 [0.30, 7.31] p=0.63 Stent Thrombosis (%) 0.15% per year---BMS like 1.0% 1.0% Low 0.3% very late stent thrombosis rates (ARC Def/Prob) between 1 and 3 years; 0% stent thrombosis rate from 2 to 3 years in 669 patients XIENCE V had a low 0.3% rate of stent thrombosis between 1 and 3 years, no new ST from years 2 to 3. 0.9% ∆0.7% ∆0.7% ∆-0.6% 0.3% 0.3% 0.3% Months Taxus Express2 was used as the control in SPIRIT III. SOURCE: David Cox SPIRIT III 3 Year Results TCT 2009
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SPIRIT IV XIENCE V TAXUS Randomized 2:1 XIENCE V:TAXUS Express2
***Clinical f/u only: 1, 6, 9 months and yearly for 1-5 years ***Pt. driven events not impacted by angiographic F/U ***Largest RCT to comparing two DES (↑ diabetic pop.) 100% monitoring: reflects high quality data arising from this trial RVD ≥2.5 mm - ≤3.75 mm; Lesion length ≤28 mm Max. 3 lesions with a maximum of 2 per epicardial vessel Pre-rand: ASA ≥300 mg, clopidogrel ≥300 mg load unless on chronic Rx 3690 pts enrolled at 66 U.S. sites Randomized 2:1 XIENCE V:TAXUS Express2 Stratified by diabetes and presence of complex lesions Pre-dilatation mandatory Everolimus-eluting XIENCE V Paclitaxel-eluting TAXUS SPIRIT IV Trial Design Key Messages Largest RCT between two DES to have presented primary endpoint data One of the largest subsets of patients with diabetes (n=1185 enrolled) Clinically-driven primary and secondary endpoints – Patient driven events not impacted by angiographic follow-up 100% monitoring – Reflective of the quality of data arising from the trial Aspirin ≥80 mg QD for 5 years; clopidogrel 75mg QD for at least 12 mos (if not at high risk for bleeding) 10 SOURCE: Gregg Stone SPIRIT IV 1 Year Results TCT 2009 10 10
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Target lesion failure (%)
SPIRIT IV: Primary Endpoint (TLF) Early & Continuously Divergent Differences HR [95%CI] = [0.46, 0.82] XIENCE V TAXUS p=0.0008 TLF = cardiac death, target vessel MI, and ischemia-driven TLR 6.6% Number Needed to Treat (NNT) to prevent one TLF Event = 37 Target lesion failure (%) Δ 2.7% TAXUS 3.9% XIENCE V XIENCE V delivers clinical superiority in the largest RCT between two DES to have presented primary endpoint data. XIENCE V proved superior to TAXUS in the clinically-driven primary endpoint of target lesion failure (TLF) (3.9% vs. 6.6%, p=0.0008) Months XIENCE V 2458 2390 2362 2323 2298 TAXUS 1229 1165 1137 1119 1104 SOURCE: Gregg Stone SPIRIT IV 1 Year Results TCT 2009
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NNT (number needed to treat) to avoid 1 ST is only 125 Patients
SPIRIT IV 1 Year Stent Thrombosis: ARC Definite or Probable XIENCE V TAXUS HR [95%CI] = 0.27 [0.11, 0.67] p=0.003 NNT (number needed to treat) to avoid 1 ST is only 125 Patients TAXUS 1.06% Stent thrombosis (%) ≈73% ↓ in S.T. at 1 year Δ 0.77% XIENCE V XIENCE V delivers long-term safety. 74% reduction in the risk of stent thrombosis (ARC def or prob) at 1 year SPIRIT IV (p=.004). 0.29% Months XIENCE V 2458 2426 2412 2388 2376 TAXUS 1229 1195 1184 1174 1166 SOURCE: Gregg Stone SPIRIT IV 1 Year Results TCT 2009
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Chronic renal failure 3 %
COMPARE Trial Prospective, single-center RCT XIENCE V vs. TAXUS Liberté in 1800 Patients AMI 25 % Calcification 34 % Multistenting 62 % Ostial 19 % Thrombus 24 % CTO 4 % NSTEMI 23 % Multivessel 27 % Saphenous graft 2 % Bifurcation 10 % Diabetes 18 % Chronic renal failure 3 % Left main 2 % Direct stenting 34 % “REAL WORLD” Therefore, we can say that the COMPARE trial truly reflects a real world situation with:……… 13 SOURCE: Smits COMPARE Trial, TCT 2009 13
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MACE (All death, non-fatal MI, and TVR)
COMPARE: XIENCE V vs. TAXUS Liberté Primary Endpoint (MACE: Death, MI and TVR) Taxus XIENCE 31% ↓ in MACE, p= 0.023 P = (log-rank test) RR = 0.69 ( ) 9.1 % Δ 2.9 % Δ 1.1% 6.2 % XIENCE V is superior to TAXUS Liberté in 1,800 real-world, all comer patients 31% reduction in the primary endpoint of MACE (p=.023) 74% reduction in the secondary endpoint of stent thrombosis (p=0.002) Benefits of XIENCE V over TAXUS translated across platforms with compelling data in SPIRIT IV and COMPARE (TAXUS is TAXUS!) This is the result of the primary end-point: the combination of all death, non fatal MI and TVR. At 12 months follow up, a significant higher incidence of MACE occurred in the Taxus stent group compared to the Xience stent group. The MACE rate is 9.1% in Taxus versus 6.2% in Xience, which is significant different according the log rank test, with a rate ratio of 0.69 and 95% Confidence Interval of Of interest is the early difference in events between both groups of 1.1% at 30 days, which gradually increased over time to 2.9% at 12 months follow-up . # Patients at Risk MACE (All death, non-fatal MI, and TVR) Taxus Xience 14 SOURCE: Smits COMPARE Trial, TCT 2009 14
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COMPARE: XIENCE V vs. TAXUS Liberté Secondary Endpoint (Stent Thrombosis)
74% ↓ in risk of stent thrombosis at 1 year P = (log-rank test) RR = 0.26 ( ) 2.6 % NNT (number needed to treat) to prevent 1 ST Event is only 53 Patients ∆ = 1.9% Definite & probable stent thrombosis rate according to the ARC definitions was also highly significant different between both groups, with a 2.6% in the Taxus group versus 0.7% in the Xience group. This is mainly due to a difference in early stent thrombosis, as shown ……(next dia) 0.7 % A.R.C. Definite & probable stent thrombosis SOURCE: Smits COMPARE Trial, TCT 2009 15
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Xience V versus Taxus Clinical Data: Level of Evidence = A
SPIRIT III – Angiographic superiority over Taxus with efficacy and safety proven long term (3-yrs) SPIRIT IV – Statistically-significant reduction in TLF and TLR as well as stent thrombosis compared to Taxus, thus showing both improved efficacy and safety, in the largest prospective RCT of DES to date COMPARE – Outstanding one year safety and efficacy data, again statistically-significant vs. TAXUS Liberte in a real world population 16
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XIENCE V : The Foundation for Future Products
DRUG/ DOSE POLYMER/ RELEASE RATE STENT MATERIAL STENT DELIVERY SYSTEM (SDS) STENT DESIGN PRODUCT Everolimus Fluorinated Copolymer Cobalt Chromium Fluorinated Copolymer Cobalt Chromium XIENCE V® ML VISION ML VISION XIENCE PRIME* NEW NEW NEW Ultra-Thin Alloy Next Gen DES* NEW NEW Bioresorbable* Polylactic Acid Polylactic Acid ML VISION NEW *Note: Pipeline products currently in development at Abbott Vascular. Not available for sale. Pictures on file at Abbott Vascular.
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Ultra-Thin New Alloy % Endothelial Coverage SEM
VISION® (844 R) Ultra-Thin NewAlloy (841 R) (839R) 839L above between overall 20 40 60 80 100 p= 0.04 p= 0.35 p= 0.045 7 days (n=8 each) UltaThin Vision UltraThin Vision UltraThin Vision above between overall 20 40 60 80 100 p= 0.37 p= 0.85 p= 0.51 11 days (n=8 each) UltraThin Vision UltraThin Vision UltraThin Vision Data expressed as a mean±SD Matched pairs analysis Pipeline product. Currently in development at Abbott Vascular. Not available for sale.
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Redesigned Delivery System Based on MULTI-LINK® FRONTIER™ Concept
Side-Branch Access DES Program: XIENCE™ Coating Technology and MULTI-LINK® FRONTIER™ Concept XIENCE™ V Coating and Materials Redesigned Delivery System Based on MULTI-LINK® FRONTIER™ Concept XIENCE™ Coating Technology Single Tip Delivery Abbott Side-Branch Access DES Dual Balloon Inflation MULTI-LINK VISION® CoCr Design In designing a DES for bifurcations, we are building on the proven Frontier platform. This stainless steel stent is uniquely designed to allow for straightforward provisional T stenting and maintaining side branch access throughout the procedure. The stent is delivered over an RX catheter with the two tips joined together. After crossing the main branch lesion, the wire joining the tips is removed and the side branch is wired. The main branch and side branch balloons inflate simultaneously. We are coupling this desing with 6th generation stent technology, based on the Multi Link Vision platform. The new product will be a Cobalt Chromium stent mounted on a modified Vision delivery system and incorporates the Xience V drug formulation coating. MULTI-LINK® FRONTIER™ Deployment Concept Flexible MULTI-LINK VISION® Catheter ML Frontier™ is neither approved nor available in the US.
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Xience SBA (Side-Branch Access) Stent Full Deployment with Side-Branch Preservation
Porcine Model On file at Abbott Vascular.
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The Fourth Revolution Fully Bioresorbable Devices The Abbott Vascular BVS Program
Everolimus-Eluting, Fully Bioresorbable Scaffold CRT 2010 Pipeline product. Currently in development at Abbott Vascular. Not available for sale.
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ABSORB: First-in-Man Serial IVUS Results – Per Treatment
Post-PCI 6-month F/U 2-year F/U % Diff (6M to 2Y) p-value n=16 Vessel (EEM) area (mm2) 13.17* 13.11* 12.56* -4.89 0.055 Lumen area (mm2) 5.99 4.92 5.60 +11.53 0.034 Plaque area (mm2) 7.44* 8.60* 7.10* -17.44 <0.001 Minimal Lumen area (mm2) 5.05 3.76 4.54 +18.32 0.005 *n=24 *n=15 Serruys, P, et al. Lancet 2009; 373: P-values per Wilcoxon’s signed rank test Pipeline product. Currently in development at Abbott Vascular. Not available for sale. 22
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BVS 3-Year Follow-Up Example of Strut Resorption by OCT
Serruys, ICI 2009 Pipeline product. Currently in development at Abbott Vascular. Not available for sale.
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A Pipeline That Will Deliver
20 Programs in Development PROGRAMS IN DEVELOPMENT PROGRAMS DES 2.25mm Next Gen DES XIENCE SBA New Alloy DES DES 4 Coronary Guide Wires 3 Next Generation BMW PROGRESS1 Next Generation HI-TORQUE® Frontline HP Versatility Next Gen Frontline BDC .014 RX Carotid/Renal BDC .014 RX BTK BDC Next Generation .035 BDC Fox sv (expanded matrix) Peripheral Drug Coated Balloon Balloon Dilatation Catheters 7 Bare Metal Stents 2 Next Gen BMS Ultra-Thin Alloy BMS Balloon Expandable Stents Balloon Expandable Peripheral Stent Renal Stent Key Messages: We have a deep product pipeline with 20 programs in development across our Coronary, Endovascular, Carotid, and Vessel Closure businesses Our pipeline cadence shows our commitment to furthering innovation and development. Continuously improving our technologies for the better treatment of patients. Our DES portfolio includes 4 new programs to improve on the outcomes of XIENCE V® plus a peripheral DES program. Plus new technologies that will change performance (new alloys, bioabsorbable devices) We are significantly ahead of competitors with our bioabsorbable device program BSX has been saying we’re a one-trick pony with XIENCE V®, but we are making significant investments across the portfolio Note: DES 2.25mm is XIENCE Nano Note: Next Gen DES is XIENCE PRIME Note: XIENCE SBA is side branch access (internally known as Pathfinder) Note: New Alloy DES is the ThinMan program 2 Bioresorbable Devices Bioresorbable Technology (BVS) 1 Self-Expanding Stents 1 Program in Development 1 Pending 510(k) clearance Note: Pipeline products currently in development at Abbott Vascular. Not available for sale.
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