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Presentation on theme: "For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved."— Presentation transcript:

1 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Resolute Integrity TM Zotarolimus-Eluting Stent System The Diabetic Patient and Long Lesions <SPEAKER>

2 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Established Components Integrity ™ cobalt alloy stentIntegrity ™ cobalt alloy stent MicroTrac ™ delivery systemMicroTrac ™ delivery system Zotarolimus antiproliferative drugZotarolimus antiproliferative drug Unique Polymer Technology BioLinx ™ polymer is a unique blend of three polymers to control drug release, support biocompatibility and enhance elution rateBioLinx ™ polymer is a unique blend of three polymers to control drug release, support biocompatibility and enhance elution rate Drug-release kinetics: complete elution by 180 daysDrug-release kinetics: complete elution by 180 days 100 80 60 40 20 0 Zotarolimus Release (%) 050100150200 Days % eluted Resolute Integrity ™ DES System Components Udipi K, et al. EuroIntervention. 2007; 3:137-9 Meredith IT, et al. J Am Coll Cardiol Intv. 2009; 2:977-85 Meredith IT, et al. EuroIntervention. 2007; 3:50-53

3 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Integrity ™ Platform Sinusoid-Formed Wire Helical Wrap Laser-Fusion A single, continuous piece of wire is taken and formed into the sinusoidal shape.A single, continuous piece of wire is taken and formed into the sinusoidal shape. A new manufacturing method for modular stent design applied in the Integrity ™ BMS and Resolute Integrity ™ DES. It is then wrapped around a mandrel to give the cylindrical shape of the stent.It is then wrapped around a mandrel to give the cylindrical shape of the stent. The stent is then fused in strategic locations to ensure maximum flexibility and conformability, without the risk of unraveling.The stent is then fused in strategic locations to ensure maximum flexibility and conformability, without the risk of unraveling. Continuous Sinusoid Technology

4 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Integrity ™ Platform Continuous sinusoid technology will flex continually Flex Stiff Flex Stiff Separate stiff segments connected by flexible connectors limit range of motion Note: Image of stents mounted on a wire over an 115°bend. Variation in bend of individual stents is a result of stent & delivery system design. 115° Bend Flex Stiff Flex ™ Integrity ™ Platform ™ Element ™ Platform ™ Multi-link ™ 8 Platform Continuous sinusoid technology allows for continuous flex, which is not possible with laser-cut stents Sinusoidal Design Allows for Continuous Flexibility

5 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Resolute Integrity ™ ZES Based on 3D tracking bench test data on file at Medtronic, Inc. Lower is Better … And Improved Deliverability Resolute Integrity ™ DES 2.50 mm x 18 mm Xience Prime ™ DES 2.50 mm x 18 mm Promus Element ™ DES 2.50 mm x 20 mm Average Push Force (gf)

6 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Resolute ™ DES Clinical Evidence

7 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 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 (R=1140; X=1152) 3 yr Non-RCT Observational (R=2349) 3 yr 2.25 – 4.0 mm Non-RCT vs. Hx Control (R=1402) 2 yr RESOLUTE US 5 2.5 – 3.5 mm Non-RCT (R=100) vs. Hx Control RESOLUTE Japan 2 yr R Japan SVS 2.25 Non-RCT vs. PG (R=65) < 1yr 38 mm sub-study Non-RCT vs. PG (R=114) < 1yr RESOLUTE Asia Non-RCT Observational (R=312) 1yr RI-US Registry Post-approval study (R=230) enrolling RESOLUTE US RESOLUTE Global Clinical Program Enrolling / Planning 1:1 RCT vs. Taxus (R=200; T=200) R-China RCT < 1yr RESOLUTE Int 4 RESOLUTE Int 4 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 Yeung AC, et al. JACC. 2011;57:1778-83. R-China Registry Non-RCT Observational (R=1800) < 1yr

8 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE All Comers 17 European sites 2300 patients randomized 1:1 Subsets: QCA 460 pts (20%); OCT 50 pts (2%) 100% monitoring 30d6mo4yr3yr2yr12mo13mo5yr Clinical endpoints Angio/OCT endpoints Co-PIs: Profs. Serruys, Silber, Windecker Clinical Trial Design Open label, non-inferiority trial Any patient with symptomatic coronary artery disease eligible for DES implantation (no lesion/vessel limitations) Open label, non-inferiority trial Any patient with symptomatic coronary artery disease eligible for DES implantation (no lesion/vessel limitations) Resolute ™ Stent n = 1,150 Resolute ™ Stent n = 1,150 Xience V ™ Stent n = 1,150 Xience V ™ Stent n = 1,150 Primary Endpoint: 12-month target lesion failure (TLF), composite of cardiac death, target vessel MI & clinically driven TLR 12-month target lesion failure (TLF), composite of cardiac death, target vessel MI & clinically driven TLR Secondary Endpoints: Clinical: Patient composite of any death, any MI, & any repeat revascularisationClinical: Patient composite of any death, any MI, & any repeat revascularisation QCA (powered): 13-month in-stent % diameter stenosisQCA (powered): 13-month in-stent % diameter stenosis QCA: % diameter stenosis, late loss, and binary restenosisQCA: % diameter stenosis, late loss, and binary restenosis Drug Therapy: ASA and clopidogrel/ticlopidine > 6mo (per guidelines) Primary Endpoint: 12-month target lesion failure (TLF), composite of cardiac death, target vessel MI & clinically driven TLR 12-month target lesion failure (TLF), composite of cardiac death, target vessel MI & clinically driven TLR Secondary Endpoints: Clinical: Patient composite of any death, any MI, & any repeat revascularisationClinical: Patient composite of any death, any MI, & any repeat revascularisation QCA (powered): 13-month in-stent % diameter stenosisQCA (powered): 13-month in-stent % diameter stenosis QCA: % diameter stenosis, late loss, and binary restenosisQCA: % diameter stenosis, late loss, and binary restenosis Drug Therapy: ASA and clopidogrel/ticlopidine > 6mo (per guidelines) Serruys PW, et al., N Engl J Med. 2010;363(2):136-46

9 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE All Comers Resolute ZES (N = 1140) Xience V EES (N = 1152) P value Age (yr) 64.4 ± 10.9 64.2 ± 10.8 0.70 Men (%) 76.777.20.80 Diabetes mellitus (%) 23.523.41.00 IDDM IDDM8.47.10.28 ACS (%) 48.347.70.80 AMI (within 12 hr) (%) 15.417.80.13 AMI (within 72 hr) (%) 28.928.80.96 Multivessel disease (%) 58.459.20.73 Lesions treated per patient 1.5 ± 0.7 1.5 ± 0.8 0.46 Small vessel (RVD ≤2.75 mm) 67.867.40.88 Long lesion (length >18 mm) 18.221.20.11 Bifurcation/trifurcation (%) 16.917.70.62 Total occlusion (%) 16.317.20.61 In-stent restenosis (%) 8.18.00.94 Complex Patients 1 (%) 67.065.60.51 1 Complex patient definition: bifurcation, bypass grafts, ISR, AMI 2 vessels stented, renal insufficiency or failure (creatinine >140 µmol/L), lesion length >27 mm, >1 lesion per vessel, lesion with thrombus or TO (preprocedure TIMI = 0). Baseline Characteristics Serruys PW, et al., N Engl J Med. 2010;363(2):136-46

10 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Time after Initial Procedure (months) Cumulative Incidence of Events 0% 01236 20% 5% 15% 10% Log rank P = 0.92 24 ™ Resolute ™ ZES (N = 1140) ™ Xience V ™ EES (N = 1152) Primary endpoint P non-inferiority <0.001 8.3% 8.2% Serruys PW, et al., N Engl J Med. 2010;363(2):136-46. Target Lesion Failure (TLF) is defined as cardiac death, TVMI, or clinically driven TLR. Target Lesion Failure to 3 Years RESOLUTE All Comers

11 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Time after Initial Procedure (months) Cumulative Incidence of Events 0% 01236 20% 5% 15% 10% Log rank P = 0.65 HR 1.05 [0.84, 1.33] 24 Target Lesion Failure to 3 Years ™ Resolute ™ ZES (N = 1140) ™ Xience V ™ EES (N = 1152) TLF (Target Lesion Failure) is defined as cardiac death, TVMI, or clinically driven TLR. 12.4% 13.1% RESOLUTE All Comers Windecker S. PCR 2012

12 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 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 (R=1140; X=1152) 3 yr Non-RCT Observational (R=2349) 3 yr 2.25 – 4.0 mm Non-RCT vs. Hx Control (R=1402) 2 yr RESOLUTE US 5 2.5 – 3.5 mm Non-RCT (R=100) vs. Hx Control RESOLUTE Japan 2 yr R Japan SVS 2.25 Non-RCT vs. PG (R=65) < 1yr 38 mm sub-study Non-RCT vs. PG (R=114) < 1yr RESOLUTE Asia Non-RCT Observational (R=312) 1yr RI-US Registry Post-approval study (R=230) enrolling RESOLUTE US RESOLUTE Global Clinical Program Enrolling / Planning 1:1 RCT vs. Taxus (R=200; T=200) R-China RCT < 1yr RESOLUTE Int 4 RESOLUTE Int 4 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 Yeung AC, et al. JACC. 2011;57:1778-83. R-China Registry Non-RCT Observational (R=1800) < 1yr 5130 Patients in Pooled Analysis

13 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 No. at risk R-ZES51305121495348014659 % CI 0.11.73.34.24.8 Target Lesion Revascularization to 2 Years RESOLUTE Pooled Efficacy Analysis Cumulative Incidence of Cardiac Death/TLR 0% 06121824 2% 10% 4% Time After Initial Procedure (months) 4.8 6% 8% 3.3 ™ Resolute ™ ZES Pooled (N = 5130) TLR is ischemia driven. *Pooled patient level data from RESOLUTE, R-AC, R-Int, R-US, R-Japan The RESOLUTE Pooled analysis was not specifically designed or powered for the analysis shown above. Belardi J. ACC 2012

14 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Resolute ™ ZES Pooled (N = 5130) Stent Thrombosis ARC Definite/Probable to 2 Years RESOLUTE Pooled Safety Analysis No. at risk R-ZES51305122501349344833 % CI 0.120.720.780.860.93 Cumulative Incidence of ARC Def/Prob ST 0% 2% 10% 4% 0.9 6% 8% 06121824 Time After Initial Procedure (months) 0.8 *Pooled patient level data from RESOLUTE, R-AC, R-Int, R-US, R-Japan The RESOLUTE Pooled analysis was not specifically designed or powered for the analysis shown above. Belardi J. ACC 2012

15 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Resolute ™ ZES Pooled* (N = 5130) Xience V ™ EES (R-AC, N = 1152) Perspective: Comparison to Xience V ™ EES in R-AC RESOLUTE Pooled Cumulative Incidence of ARC Def/Prob ST 0% 2% 10% 4% 0.9 6% 8% 06121824 Time After Initial Procedure (months) 0.8 1.0 0.7 Stent Thrombosis (ARC Definite/Probable) Cumulative Incidence of Cardiac Death/TVMI 0% 2% 10% 4% 5.4 6% 8% 06121824 Time After Initial Procedure (months) 3.9 6.2 5.5 Cardiac Death/Target Vessel MI Cumulative Incidence of TLF 0% 5% 20% 10% 9.3 15% 6.6 06121824 Time After Initial Procedure (months) 10.7 8.5 Target Lesion Failure Cumulative Incidence of TLR 0% 06121824 2% 10% 4% Time After Initial Procedure (months) 4.8 6% 8% 3.3 5.2 3.5 Target Lesion Revascularization * Post-hoc pooled patient level analysis from RESOLUTE, R-AC, R-Int, R-US, R-Japan. TLR is ischemia driven. HR and p-values based on Cox regression model adjusted with propensity score quintiles. Some of the baseline variables and DAPT durations were significantly different. Actual rates may differ in a head-to-head comparison. Outcomes remain consistent when adjusted for duration of DAPT and other variables. P = 0.90 HR = 1.05 95% CI (0.53, 2.09) P = 0.08 HR = 0.83 95% CI (0.67, 1.02) P = 0.18 HR = 0.83 95% CI (0.63, 1.09) P = 0.50 HR = 0.90 95% CI (0.67, 1.22) Belardi J. ACC 2012

16 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013RESOLUTE139 RESOLUTE AC 1140 RESOLUTE Int 2349 RESOLUTE US 1402 RESOLUTE Japan 100 5130 Resolute ™ population Matched cohort diabetic population N = 878 (standard risk) Matched cohort is all enrolled diabetic subjects excluding subjects with bifurcation, saphenous vein graft (SVG), ISR, AMI (≤72 hours), left ventricular ejection fraction (LVEF) 27 mm, ≥2 lesions per vessel, lesion with thrombus, or lesion with total occlusion.Yeung A. ACC 2012 Diabetic Patient Populations RESOLUTE Pooled Diabetic Analysis Total diabetic patient population N = 1535 Standard risk patient cohort pre-specified for FDA indication

17 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE Pooled Diabetic Analysis Prespecified diabetes analysis designed with FDA for diabetes indication Performance goal prespecified based on meta-analysis: DIABETES, RAVEL DM, SIRIUS DM, TAXUS IV, SCORPIUS, ENDEAVOR Pooled DM. Standard risk patient population from Pooled RESOLUTE matched to performance goal patient population First DES with FDA Indication Performance Goal Resolute ™ DES † TVF: target vessel failure (cardiac death, TV-MI, and clinically driven TVR) † RESOLUTE matched cohort diabetes pooled analysis (N = 878).Yeung A. ACC 2012 TVF at 12 Months (powered endpoint) TVF at 12 Months (powered endpoint) 14.5 7.8 P = 0.001 Events (%)

18 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE Pooled Diabetic Analysis TLRCardiac Death TVMI ST (ARC Def/Prob) TLF Standard Risk Pts – Clinical Outcomes at 24 Months Events (%) RESOLUTE Pooled analysis, Standard risk diabetics (n=861/878) TVF TLR is ischemia driven. Resolute Pooled standard risk diabetic analysis was not specifically designed or powered for the endpoints other than TVF. Yeung A. ACC 2012

19 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Resolute ™ ZES: 38mm Presented by Dr. Hiremath TCT 2012

20 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Diabetic patients with CAD tend to have an increased prevalence of long and diffuse lesions. Implantation of drug-eluting stents in long coronary artery lesions is associated with a higher risk for restenosis and stent thrombosis related to the need for multiple and overlapping stents. ™Historical data indicate that the XIENCE PRIME LL ™ stent is associated with a 1yr TLF rate of 7.7% in long lesions 1. Furthermore a recent publication showed no statistical differences at 1 year between R-ZES and SES for the treatment of long coronary artery lesions 2. 1 Costa, M. et al. presented at TCT2011 2 Ahn, J-M, et al. Circ Cardiovasc Interv. 2012 Oct 9. [Epub ahead of print] Background RESOLUTE 38mm Adapted from Hiremath S. TCT 2012

21 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 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 (R=1140; X=1152) 3 yr Non-RCT Observational (R=2349) 3 yr 2.25 – 4.0 mm Non-RCT vs. Hx Control (R=1402) 2 yr RESOLUTE US 5 2.5 – 3.5 mm Non-RCT (R=100) vs. Hx Control RESOLUTE Japan 2 yr R Japan SVS 2.25 Non-RCT vs. PG (R=65) < 1yr 38 mm sub-study Non-RCT vs. PG (R=114) < 1yr RESOLUTE Asia Non-RCT Observational (R=312) 1yr RI-US Registry Post-approval study (R=230) enrolling RESOLUTE US RESOLUTE Global Clinical Program Enrolling / Planning 1:1 RCT vs. Taxus (R=200; T=200) R-China RCT < 1yr RESOLUTE Int 4 RESOLUTE Int 4 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 Yeung AC, et al. JACC. 2011;57:1778-83. R-China Registry Non-RCT Observational (R=1800) < 1yr 2 Trials with Data for 38mm Resolute Stents

22 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE 38mm RESOLUTE US N = 1402 38mm Substudy N = 114 38mm Substudy N = 109 RESOLUTE Asia N = 312 38 mm Substudy N = 223 1 Year Follow-up n = 222 (99.6%) Patient Flowchart Hiremath S. TCT 2012

23 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 % N = 223 pts Age (yr) 60.9 ± 10.6 Male78.9 Diabetes mellitus37.7 IDDM10.3 Hypertension74.9 Hyperlipidemia58.7 Current smoker18.8 Family history of CAD37.2 Prior MI32.4 Prior PCI27.4 Prior CABG7.2 Cardiac status: Stable angina39.2 Unstable angina47.4 Myocardial infarction13.4 Baseline Characteristics RESOLUTE 38mm Hiremath S. TCT 2012

24 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 N = 223 pts, 269 lesions Number of diseased vessels (>50%) Single 46.2 Double36.3 Triple17.5 Lesion location LAD52.0 LCx20.2 RCA44.4 Lesion length Discrete (<10mm)4.6 Tubular (10-19.9mm)24.5 Diffuse (> 20mm)70.9 Branch vessel disease47.9 B2/C lesion91.2 Lesion length (mm) 25.22 ± 8.83 RVD (mm) 2.78 ± 0.42 MLD (mm) 0.80 ± 0.36 Pre-procedure % diameter stenosis71.33 ± 11.61 Lesion & Procedure Characteristics RESOLUTE 38mm QCA measurements may have been made by careful visual estimate, on-line QCA or IVUS. Hiremath S. TCT 2012

25 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 % N = 223 patients, 269 lesions Lesion success (the attainment of <50% residual stenosis of the target lesion using any percutaneous method) 100% Device success (the attainment of <50% residual stenosis of the target lesion using only the assigned device) 97.0% Procedure success (the attainment of <50% residual stenosis of the target lesion and no in-hospital MACE) 96.3% Acute Success Rates RESOLUTE 38mm Hiremath S. TCT 2012

26 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE 38mm Dual Antiplatelet Therapy (DAPT) Usage Time After Initial Procedure (months) Patients on DAPT (%) 92.3 91.4 90.0 89.5 Hiremath S. TCT 2012

27 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Clinical Outcomes at 1 Year RESOLUTE 38mm Target lesion failure (TLF) is defined as cardiac death, target vessel MI and clinically driven TLR. Primary endpoint of TLF at 12 months was 5.4% with a one-sided 95% upper confidence bound of 8.6%, which was significantly less (P < 0.01) than the performance goal of 19.0%. Events [%] TLF Performance goal Primary endpoint met P < 0.01 Resolute ™ 38mm (n = 222) Hiremath S. TCT 2012

28 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 RESOLUTE 38mm % 30 Days n = 223 6 Months n = 223 12 Months n = 222 Death (all) 0.40.40.9 Cardiac0.40.40.9 MI (target vessel) 3.63.63.6 Q Wave 0.90.90.9 Non Q wave 2.72.72.7 Cardiac death + target vessel MI 4.04.04.5 ST Def/Prob (all) 0.90.90.9 Early (< 30 days) 0.90.90.9 Late (31-360 days) --00 TLR0.90.91.4 TVR0.91.32.7 TLF (cardiac death, TV-MI, TLR) 4.54.55.4 TVF (cardiac death, TV-MI, TVR) 4.54.96.8 Clinical Outcomes at 1 Year ST occurred in one patient on day 1 (probable ST) and in a second patient on day 4 (definite ST). TLR and TVR are clinically driven. Hiremath S. TCT 2012

29 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 TLR Cardiac Death TV-MI ST (ARC Def/Prob) TLF Events [%] Clinical Outcomes at 1 Year RESOLUTE 38mm – Diabetic Patients Diabetic, 38mm patients (n = 84) Non-Diabetic, 38mm patients (n = 138) P = 0.79P = 0.64P = 0.52P = 0.49 P = 0.20 All P-values are adjusted by propensity score for differences in baseline characteristics. TLF (Target Lesion Failure) is defined as cardiac death, TVMI, or clinically driven TLR. Hiremath S. TCT 2012

30 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Conclusions Stent Design The Resolute Integrity ™ zotarolimus-eluting stent utilizes novel continuous sinusoid technology (CST).The Resolute Integrity ™ zotarolimus-eluting stent utilizes novel continuous sinusoid technology (CST). With CST, a single cobalt alloy wire is formed into a repeating sinusoidal pattern, wrapped helically and fused to improve conformability, provide greater flexibility and excellent deliverability 1With CST, a single cobalt alloy wire is formed into a repeating sinusoidal pattern, wrapped helically and fused to improve conformability, provide greater flexibility and excellent deliverability 1 Clinical Outcomes Resolute ™ DES is as safe and effective as Xience V ™ DES in an all-comers population 2,3,4Resolute ™ DES is as safe and effective as Xience V ™ DES in an all-comers population 2,3,4 Pooled analysis showed consistent clinical performance in over 5,000 patients studied 5Pooled analysis showed consistent clinical performance in over 5,000 patients studied 5 Diabetic indication First and only DES FDA-approved for patients with diabetesFirst and only DES FDA-approved for patients with diabetes Pooled data indicated consistent low adverse events rates with the Resolute ™ stent out to 2 years (4.8% TLR, 0.3% ST) despite the higher risk nature of this patient population 6Pooled data indicated consistent low adverse events rates with the Resolute ™ stent out to 2 years (4.8% TLR, 0.3% ST) despite the higher risk nature of this patient population 6 Long lesions The 38mm length R-ZES was safe and effective in a selected population of long lesion patients 7The 38mm length R-ZES was safe and effective in a selected population of long lesion patients 7 1 Based on bench test data on file at Medtronic, Inc. 2 Serruys PW, et al. N Engl J Med. 2010;363:136-46. 3 Silber S, et al. Lancet. 2011; 377:1241-47. 4 Windecker S. PCR 2012 5 Belardi J. ACC 2012 6 Yeung A. ACC 2012 7 Hiremath S. TCT 2012

31 For distribution in the USA only. Trademarks may be registered and are the property of their respective owners. © 2013 Medtronic, Inc. All rights reserved. UC201304600aEN 02/2013 Indications The Resolute Integrity Zotarolimus-Eluting Coronary Stent System is indicated for improving coronary luminal diameters in patients, including those with diabetes mellitus, with symptomatic ischemic heart disease due to de novo lesions of length ≤35 mm in native coronary arteries with reference vessel diameters of 2.25 mm to 4.20 mm. Contraindications The Resolute Integrity Zotarolimus-Eluting Coronary Stent System is contraindicated for use in: Patients with a known hypersensitivity or allergies to aspirin, heparin, bivalirudin, clopidogrel, prasugrel, ticagrelor, ticlopidine, drugs such as zotarolimus, tacrolimus, sirolimus, everolimus or similar drugs or any other analogue or derivative Patients with a known hypersensitivity to the cobalt-based alloy (cobalt, nickel, chromium and molybdenum) Patients with a known hypersensitivity to the BioLinx ® polymer or its individual components Coronary artery stenting is contraindicated for use in: Patients in whom antiplatelet and/or anticoagulation therapy is contraindicated Patients who are judged to have a lesion that prevents complete inflation of an angioplasty balloon or proper placement of the stent or stent delivery system Warnings Please ensure that the inner package has not been opened or damaged as this would indicate the sterile barrier has been breached. The use of this product carries the same risks associated with coronary artery stent implantation procedures, which include subacute and late vessel thrombosis, vascular complications and/or bleeding events. This product should not be used in patients who are not likely to comply with the recommended antiplatelet therapy. Precautions Only physicians who have received adequate training should perform implantation of the stent. Stent placement should only be performed at hospitals where emergency coronary artery bypass graft surgery can be readily performed. Subsequent stent restenosis or occlusion may require repeat catheter-based treatments (including balloon dilatation) of the arterial segment containing the stent. The long-term outcome following repeat catheter-based treatments of previously implanted stents is not well characterized. The risks and benefits of the stent implantation should be assessed for patients with a history of severe reaction to contrast agents. Do not expose or wipe the product with organic solvents such as alcohol. When drug- eluting stents (DES) are used outside the specified Indications for Use, patient outcomes may differ from the results observed in the RESOLUTE pivotal clinical trials. Compared to use within the specified Indications for Use, the use of DES in patients and lesions outside of the labeled indications, including more tortuous anatomy, may have an increased risk of adverse events, including stent thrombosis, stent embolization, myocardial infarction (MI), or death Care should be taken to control the position of the guide catheter tip during stent delivery, deployment, and balloon withdrawal. Before withdrawing the stent delivery system, visually confirm complete balloon deflation by fluoroscopy to avoid guiding catheter movement into the vessel and subsequent arterial damage Stent thrombosis is a low-frequency event that is frequently associated with MI or death. Data from the RESOLUTE clinical trials have been prospectively evaluated and adjudicated using the definition developed by the Academic Research Consortium (ARC). The safety and effectiveness of the Resolute Integrity stent have not yet been established in the following patient populations: Patients with target lesions which were treated with prior brachytherapy or the use of brachytherapy to treat in-stent restenosis of a Resolute Integrity stent Women who are pregnant or lactating Men intending to father children Pediatric patients Patients with coronary artery reference vessel diameters of 4.20 mm Patients with coronary artery lesions longer than 35 mm or requiring more than one Resolute Integrity stent Patients with evidence of an acute MI within 72 hours of intended stent implantation Patients with vessel thrombus at the lesion site Patients with lesions located in a saphenous vein graft, in the left main coronary artery, ostial lesions or bifurcation lesions Patients with diffuse disease or poor flow distal to identified lesions Patients with tortuous vessels in the region of the target vessel or proximal to the lesion Patients with in-stent restenosis Patients with moderate or severe lesion calcification at the target lesion Patients with occluded target lesions including chronic total occlusions Patients with three-vessel disease Patients with a left ventricular ejection fraction of 2.5mg/dl Patients with longer than 24 months of follow-up The safety and effectiveness of the Resolute Integrity stent have not been established in the cerebral, carotid or peripheral vasculature. Potential Adverse Events Other risks associated with using this device are those associated with percutaneous coronary diagnostic (including angiography and IVUS) and treatment procedures. These risks (in alphabetical order) may include but are not limited to: Abrupt vessel closure Access site pain, hematoma or hemorrhage Allergic reaction (to contrast, antiplatelet therapy, stent material, or drug and polymer coating) Aneurysm, pseudoaneurysm, or arteriovenous fistula (AVF) Arrhythmias, including ventricular fibrillation Balloon rupture Bleeding Cardiac tamponade Coronary artery occlusion, perforation, rupture or dissection Coronary artery spasm Death Embolism (air, tissue, device or thrombus) Emergency surgery: peripheral vascular or coronary bypass Failure to deliver the stent Hemorrhage requiring transfusion Hypotension/hypertension Incomplete stent apposition Infection or fever MI Pericarditis Peripheral ischemia/peripheral nerve injury Renal failure Restenosis of the stented artery Shock/pulmonary edema Stable or unstable angina Stent deformation, collapse, or fracture Stent migration (or embolization) Stent misplacement Stroke/transient ischemic attack Thrombosis (acute, subacute or late) Adverse Events Related to Zotarolimus Patients’ exposure to zotarolimus is directly related to the total amount of stent length implanted. The actual side effects/complications that may be associated with the use of zotarolimus are not fully known. The adverse events that have been associated with the intravenous injection of zotarolimus in humans include but are not limited to: Anemia Diarrhea Dry skin Headache Hematuria Infection Injection site reaction Pain (abdominal, arthralgia, injection site) Rash Please reference appropriate product Instructions for Use for more information regarding indications, warnings, precautions and potential adverse events. CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. For further information, please call and/or consult Medtronic at the toll-free numbers or websites listed. Resolute DES Safety Information


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