1. Final Three-Year Outcome of a Randomized Trial Comparing Second Generation Drug-eluting Stents Using Either Biodegradable Polymer or Durable Polymer The NOBORI Biolimus-Eluting versus XIENCE/PROMUS Everolimus-eluting Stent Trial (NEXT) Masahiro Natsuaki, MD Kyoto University Graduate School of Medicine, Saiseikai Fukuoka General Hospital Ken Kozuma, MD; Takeshi Morimoto, MD, MPH; Kazushige Kadota, MD; Toshiya Muramatsu, MD, Yoshihisa Nakagawa, MD, Takashi Akasaka, MD; Keiichi Igarashi, MD; Kengo Tanabe, MD; Yoshihiro Morino, MD; Tetsuya Ishikawa, MD; Hideo Nishikawa, MD; Masaki Awata, MD; Masaharu Akao, MD; Hisayuki Okada, MD; Yoshiki Takatsu, MD; Nobuhiko Ogata, MD; Kazuo Kimura, MD; Kazushi Urasawa, MD; Yasuhiro Tarutani, MD; Nobuo Shiode, MD; and Takeshi Kimura, MD On behalf of the NEXT Investigators

2. Potential conflicts of interest Speaker's name: Masahiro Natsuaki  I do not have any potential conflict of interest Study sponsor: Terumo Japan

3. Background COMPARE II Cardiac death, myocardial infarction and TVR at 3-year Smits P. EuroPCR 2014. The advantage of coronary stent using biodegradable polymer could emerge beyond 1-year after stent implantation, when polymer has been fully degraded. However, there are only a few randomized controlled trials other than the NEXT reporting the clinical outcomes beyond 1-year after biodegradable polymer biolimus-eluting stent (BP-BES) implantation as compared with durable polymer everolimus-eluting stent (DP-EES) implantation. Therefore, we report the clinical outcomes of BP-BES compared with DP-EES through 3-year and beyond 1-year after stent implantation in the largest ever reported prospective multicenter randomized open label trial.

4. Randomization 1:1 3235 patients scheduled for PCI using drug-eluting stent No Exclusion Criteria (All-comer Design) NEXT Trial Multicenter, randomized, non-inferiority trial comparing BP-BES with DP-EES 3-Year Clinical Follow-up (N=3158; 97.6%) DP-EES (N=1582) <1035 days follow-up: N=36 BP-BES (N=1576) <1035 days follow-up: N=41 Enrollment from 98 Japanese centers between May and October, 2011 Nobori BP-BES (N=1617) Xience/Promus DP-EES (N=1618) Efficacy: Target lesion revascularization at 1-year Safety: Death or Myocardial Infarction at 3-year 3000 patients would yield 91% power to detect non-inferiority with the non-inferiority margin of 4.3% (True rate 12.2%)

5. BP-BES (1617)DP-EES (1618)P Age (years)69.1 ± 9.869.3 ± 9.80.49 Male gender77 % 0.76 Diabetes46 % 0.85 Hypertension81 %82 %0.81 Prior PCI50 %51 %0.9 Clinical diagnosis0.62 Acute myocardial infarction5.1 %4.5 % Unstable angina12 %11 % Stable coronary artery disease83 %84 % Hemodialysis6.5 %5.2 %0.11 Prior myocardial infarction 28 % 0.81 Prior stroke10 %11 %0.43 Multivessel disease51 % 0.9 SYNTAX score10 (6-17)10 (6-16)0.17 No. of lesions treated per patient1.27 ± 0.561.24 ± 0.510.1 No. of stents per patient1.59 ± 0.841.6 ± 0.830.74 Total stent length per patient (mm)33.0± 20.332.9 ± 20.70.87 Stent diameter (mm)2.88 ± 0.672.87 ± 0.640.7 Multivessel treatment13%11%0.21 Baseline Characteristics

6. 0% 1.0%-1.0%2.0%4.0% 4.3% BP-BES 9.9% vs. DP-EES 10.3% P non-inferiority < 0.0001 Difference: -0.44% Upper one-sided 97.5% CI: 2.2% Non-inferiority Assessment for the Primary Safety Endpoint Death or Myocardial Infarction at 3-year Non-inferiority margin 2.2% 3.0% 5.0%

7. Death or Myocardial Infarction 1.0%-1.0%2.0%4.0% 3.0% 5.0% Target Lesion Revascularization Cumulative 3-year Incidence Primary Safety Endpoint Primary Efficacy Endpoint Cumulative Incidence (%) DP-EES BP-BES Log-rank P=0.7 Days after PCI Interval0 day365 days730 days1095 days BP-BES group N of patients with at least 1 event 89126159 N of patients at risk1617152414781416 Cumulative Incidence5.5%7.8%9.9% DP-EES group N of patients with at least 1 event 87124166 N of patients at risk1618152914821413 Cumulative Incidence 5.4%7.7%10.3% DP-EES BP-BES Days after PCI Log-rank P=0.8 Interval0 day365 days730 days1095 days BP-BES group N of patients with at least 1 event 6899116 N of patients at risk1617150614321353 Cumulative Incidence4.3%6.3%7.4% DP-EES group N of patients with at least 1 event 7297112 N of patients at risk1618150614401359 Cumulative Incidence 4.5%6.1%7.1% 10.3% 7.1% 9.9% 7.4%

8. Clinical Outcomes at 3-Year 6.8% P = 0.85 7.0% DeathCardiac death P = 0.57 2.7% 2.4% Stent thrombosis P = 0.74 0.31% 0.26% Stroke 3.1% 3.2% P = 0.93 11.3% 9.9% P = 0.21 TVR MI 4.0% 3.7% P = 0.72 BP-BES DP-EES Cumulative Incidence

9. 7301095 7301095 0% 10% 20% 0 Death or Myocardial Infarction 1.0%2.0%4.0% 3.0% Target Lesion Revascularization Primary Safety Endpoint Primary Efficacy Endpoint Cumulative Incidence (%) DP-EES BP-BES Landmark Analysis at 1-year 0% 10% 20% 0 Log-rank P=0.88 Log-rank P=0.46 DP-EES BP-BES Log-rank P=0.72 Log-rank P=0.39 5.4% 5.2% 4.5% 2.7% 5.5% 4.6% 4.3% 3.3% 365 Definite Stent Thrombosis 7301095 0% 2.5% 5% 0365 DP-EES BP-BES Log-rank P=0.18 Log-rank P=0.32 0.25% 0.07% 0.06% 0.2% DP-EES: 0.1%/year BP-BES: 0.04%/year

10. Conclusions The safety and efficacy outcomes of BP-BES remained comparable to those of DP-EES through 3-year and beyond 1-year after stent implantation. There was no apparent signal suggesting either improvement or impairment of clinical outcomes with BP-BES compared with DP-EES. Longer-term follow-up is mandatory to fully understand whether BP-BES could provide any long-term benefit over DP-EES.