1. DR ALEX CHASE REGIONAL HEART CENTRE MORRISTON SWANSEA SLIDE MATERIAL:PERSONAL COMMUNICATION WITH AUTHORS ABBOTT, BOSTON SCIENTIFIC, CORDIS, MEDTRONIC TCT WEBSITE: www.tcdmd.com

2. 12 registries of DES use in 12 months DR ALEX CHASE REGIONAL HEART CENTRE MORRISTON SWANSEA do they work? are they safe?

3. Swedish Coronary Angiography and Angioplasty Registry Adjusted Death 2003-04 N= 19 771 R.R. 1.32 95% CI (1.11 to 1.57) R.R. 1.09 95% CI (0.96 to 1.25) NEJM TCT 07 N= 35262 Adjusted Death 2003-05 2005 2006 % DES / month 2003- 21% DES R.R. 0.93 95% CI (0.76 to 1.13) 2005- 53.1% DES R.R. 1.31 95% CI (1.12 to 1.53) TCT 07 no difference in death or MI or both DES ‘on’ or ‘off’ all reproduced in single stent cohort tctmd.com

4. 2-yearMultiple Italy (13) 2002-2005 Real-world registry evaluating outcomes of DES and BMS 10,629 3,064 / 7,565 REAL 1-yearMultiple U.S. 2004 -2006 (3 waves) STEMI excluded Evaluation of DES used on and off-label and over time 3,323 (all DES) 1506 on / 1817 off EVENT 3 year MultipleSweden (26) 2003-04 Real-world registry evaluating outcomes of DES and BMS 19,771 6033 / 13738 SCAAR 2-yearMultiple Denmark (Multiple) 2002-05 Real-world registry evaluating outcomes of DES and BMS 12,395 3,548 / 8,247 Western Denmark 2-yearMultiple U.S. (MA) 2003-05 Propensity-matched analysis of DES vs. BMS outcomes 17,726 11,516 / 6,210 Massachusetts Evaluation of DES and BMS in an unrestricted patient population Landmark analysis comparing DES and BMS Case-matched propensity analysis of DES vs. BMS Real-world registry evaluating outcomes of DES and BMS Long-term evaluation of DES vs. BMS mortality in ST & NSTAMI patients Evaluation of DES and BMS used in all comers in off-label Real-world registry evaluating outcomes of DES and BMS Study Description 3,223 1460 / 1763 7,355 5,996 / 1,359 7,502 3751 / 3751 14,218 6,384 / 7,834 11,118 5719 / 5399 1,354 483 / 871 7,221 3,160 / 4,061 Number of Pts DES / BMS Multiple Single Number of Sites 1-year U.S. BMS 2001-02 DES 2004 NHLBI Dynamic Registry 2-yearU.S. (Southeast)STENT 2-3-year Canada Dec 03-Mar 05 Ontario 2-yearU.S. (NY)NY State Registry 2-year U.S. (NJ) did not report TVR MIDAS 2-3-year U.S. (PA) *(1)* 35% STEMI GHOST 3-year Korea *(1)* did not report TVR ASAN Years of Follow Up CountryRegistry

5. do they work? revasc are they safe? mortality DES BMS

6. are they safe? MI thrombosis DES BMS

7. summary & any other business several studies (SCAAR, NHLBI, GHOST & EVENT demonstrated the safety and efficacy of DES off label (NHLBI :Greatest benefit TVR on label ( HR 0.44, 95% CI 0.28 ) vs off (HR 0.57, 95% CI 0.39 to 0.83) indications) GHOST: > 12 months dual anti-platelet was an advantage on sub-analysis several studies (MIDAS, ONTARIO, STENT & NY, ASAN & MASSACHUSETTS) demonstrated mortality benefit of DES vs BMS including STEMI and NSTEMI

8. TCT 2007 Bifurcations Bad Krozingen M. Ferenc, H.J. Buettner, H.-P. Bestehorn, M. Gick, T. Comberg, K. Werner, J. Allgeier, J. Minners, R.-P. Kienzle F.-J. Neumann Heart Center Bad Krozingen / Germany ClinicalTrials.gov Identifier: NCT00288535 Cordis, Johnson & Johnson Company “The opposite of simple is not complicated, but wrong” “keep it simple stupid” “Avoid second stent at all costs” Systematic versus provisional T-stenting in the treatment of de novo coronary bifurcation lesions using sirolimus-eluting stents

9. hypothesis In the treatment of coronary bifurcation lesions with sirolimus- eluting stents (CYPHER) systematic T-stenting of both main and the side branch reduces the restenosis in the side branch compared with provisional T-stenting TCTMD.com

10. matched for lesion characteristics Medina A. Rev Esp Cardiol. 2006 Feb;59(2):183 1 3 2

11. angiographic endpoints @ 9 months

12. clinical endpoints @ 1 year

13. conclusions Compared with provisional T-stenting, systematic T-stenting does not reduce in- segment percent diameter stenosis of the side branch. Provisional T-stenting yields a similar angiographic and clinical outcome as the more consumptive systematic T-stenting.

14. Endeavor IV & Spirit III

15. Taxus Endeavor colbalt alloy steel zotarolimus x 500 paclitaxel matched lesion characteristics matched post-procedural QCA 82.3% to 98.1% FU Endeavor IV- design & demographics *TVF = cardiac death, MI, or ischemia-driven TVR *

16. 8 month QCA 12 month clinical 1 o endpoint TVF @ 9 months non Q MI@ 30 days Endeavor 0.5%(4) vs Taxus 2.2%(17) diabetics risk TVF 9 months 7.7%(18) vs 8.4%(19) RR 0.91, p=0.99 Endeavor IV- the mesage -

17. Endeavor IV - authors’ conclusions

18. SPIRIT III - design & demographics PI: Gregg Stone, MD, 65 US sites RCT: Prospective, single blind Primary end point: In-segment Late Loss at 8M Stent Size: 2.5 – 3.5mm 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 $$$ Abbott 2:12:1 Up to two de novo lesions, maximum of one lesion per epicardial vessel Main US RCT 2.5 – 3.75 mm LL ≤ 28 mm N = 1,002 XIENCE V N = 669 TAXUS ® Control N = 333 Stone ACC 2007 1002 pts everolimus paclitaxel

19. % event @ 12 months SPIRIT III – the message Xience Taxus

20. lunch