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Current Absorb Implantation Mechanism – non-TGA approved device ♥ ABSORB EXTEND Trial – HREC Approval POWH/EHC 2010
Defined, relatively restrictive anatomical criteria n = 28
♥ “Real-world” Registry – TGA/HREC Approval 2012
Authorized Prescriber (3) Interventionalists Long lesions, younger patients Real-world patients and disease n = 219
Eastern Heart Clinic/Prince of Wales Hospital
BRS Utilization
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Eastern Heart Clinic/Prince of Wales Hospital
BRS Utilization
Inclusion Criteria ♥ Younger patients < 65 ♥ Longer lesions (> 28mm) ♥ Mid LAD disease ♥ Reference vessel diameter suitable
for 2.5, 3.0 or 3.5 mm Absorb ♥ All patients eligible for PCI ♥ Life expectancy > 5 yrs
“Real-world” Registry�
Exclusion Criteria ♥ Instent restenosis ♥ Residual unexpanded lesion > 30% after
preparation ♥ Extreme calcification ♥ Extreme proximal tortuosity ♥ Inability to maintain DAPT for 12 mths ♥ Cardiogenic Shock ♥ Planned major surgery within 6 mths ♥ Participation in another trial ♥ No informed consent
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Base-line Demographics - Dec 2010 - Aug 2014
Eastern Heart Clinic/Prince of Wales Hospital Real-World BRS Experience
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N 247 (263 procedures)
Age (yrs/range) 61 (18-83) Male (%) 74
DM (%) 18 Hypertension (%) 78
Prior MI (%) 17 Hyperlipidaemia (%) 83
CKD (%) 6 Prior PCI (%) 21 Prior CABG (%) 10
N 247 (263 procedures)
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Procedural Details
Eastern Heart Clinic/Prince of Wales Hospital Real-World BRS Experience
��CTO (%) 6
Long lesions (%) 32
Bifurcations (%) 21
Moderate/severe calcification (%) 23
B2/C lesion complexity(%) 54
Bifurcations (%) 21
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Clinical Outcomes
Eastern Heart Clinic/Prince of Wales Hospital Real-World BRS Experience
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100 % 30 d, 39% 12 mth, 12% 24 mth
Peri-procedural non-Q MI n (%) 6 (2.4)
Deaths n (%) 2 (0.8) Cardiac Deaths n (%) 1 (0.4)
TVR n (%) 6 (2.4)
TLR n (%) 3 (1.2)
MACE n (%) 15 (6.1) Scaffold thromboses – Definite/probable n (%) 1 (0.4)
Scaffold thromboses – Possible n (%) 1 (0.4)
MI (spontaneous) n (%) 1(0.4)
TVR n (%) 6 (2.4)
TLR n (%) 3 (1.2)
Cardiac Deaths n (%) 1 (0.4)
TVR (%) 6 (2 4)
MACE n (%) 15 (6.1) Scaffold thromboses – Definite/probable n (%) 1 (0.4)
S ff ld th b P ibl (%) 1 (0 4)
S ff ld th b D fi it / b bl (%) 1 (0 4)
CIT 2014, HLC (in press)�
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Baseline characteristics �;<=
Age (yrs/range) 56 (43-80) Male (%) 84 DM (%) 19 Hypertension (%) 71 Prior MI (%) 15 Hyperlipidaemia (%) 95 CKD (%) 6 Prior PCI (%) 25 Prior CABG (%) 7
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Indications for PCI �;<=
Stable angina, n(%) 37 (71) Non-STE ACS, n (%) 15 (29) STEMI, n (%) 0
Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
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Lesion/vessel characteristics �� ���!����&���;<<
LM/LAD, LM/Cx n (%) 4 (7.3) LAD/Diag n (%) 28 (50.9)
LCx/OM n (%) 9 (16.4) RCA (PL/PDA) n (%) 14 (25.5)
True bifurcations (111/101/011) n (%)
29 (52.7)
100 n (%) 3 (5.5) 010 n (%) 5 (9.1) 110 n (%) 14 (25.5) Ostial SB only (001) n (%) 4 (7.3)
Type B/C n (%) 48 (87.3) Calcification (mod/heavy) n (%) 20 (36.4) CTO n (%) 10 (18.2)
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
LAD/Diag n (%) 28 (50.9)
True bifurcations (111/101/011) n (%)
29 (52.7)
Ostial SB only (001) n (%) 4 (7.3)
Type B/C n (%) 48 (87 3)Calcification (mod/heavy) n (%) 20 (36.4) CTO n (%) 10 (18 2)
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
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RCA CTO – 51 yo male, SAP �
POW/EHC Absorb Registry - Case # 153
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RCA CTO – 51 yo male, SAP Bifurcation dRCA
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RCA CTO – 51 yo male, SAP Bifurcation dRCA
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POW/EHC Absorb Registry - Case # 153
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RCA CTO – 51 yo male, SAP Bifurcation dRCA
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POW/EHC Absorb Registry - Case # 153
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
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Set-up
Bifurcation Circumflex Disease - Staged 53 yo male, recent RCA DES (STEMI – PPCI) + staged Absorb BRS x 3 LAD
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POW/EHC Absorb Registry - Case # 118
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2.5 mm balloon
Bifurcation Circumflex PCI – 53 yo male
Post-predilatation
POW/EHC Absorb Registry - Case # 118
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2.5 x 12 mm Absorb
Bifurcation Circumflex PCI – 53 yo male
POW/EHC Absorb Registry - Case # 118
3.0 x 18 mm Absorb
Two scaffold strategy – Shunt/modified T
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2.0 mm balloon
Bifurcation Circumflex PCI – 53 yo male
3.5 mm balloon
Sequential kiss
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Bifurcation Circumflex PCI – 53 yo male
OCT post-Sequential kiss
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Final kissing balloons – 2.5 mm NC balloons x 2 Minimal overlap Low pressure 8atm
Bifurcation Circumflex PCI – 53 yo male
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Final Result (OCT guided)
Bifurcation Circumflex PCI – 53 yo male
POW/EHC Absorb Registry - Case # 118
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Final Result (OCT guided)
Bifurcation Circumflex PCI – 53 yo male
POW/EHC Absorb Registry - Case # 118
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
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LAD/D1 (011) Bifurcation – 57 yo male, SAP DK Crush
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POW/EHC Absorb Registry - Case # 108
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LAD/D1 (011) Bifurcation – 57 yo male, SAP DK Crush
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LAD/D1 (011) Bifurcation – 57 yo male, SAP DK Crush
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POW/EHC Absorb Registry - Case # 108
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
Procedural Characteristics n= 55 Bifurcations
Pre-dilatation (%) 100 Rotablator/scoring balloon (%) 6 Multi-vessel BVS (%) 35 Total scaffolds (n) 87 Scaffolds/patient (n/range) 1.7 (1-3) OCT (%) 27 NC balloon post-dilatation (%) 100 Concomitant DES (%) 20
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
Procedural Characteristics n= 55 Bifurcations
MAIN VESSEL BVS number (n) 1.6 BVS diameter (mm) 2.91 Total BVS length (mm) 37.3
SIDE BRANCH BVS number (n) 0.15 BVS diameter (mm) 2.68
Total BVS length (mm) 15
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
Procedural Results �;<=��!����,�;<<�������
Procedural success (%) 100
Device success (%) 100
Failure to deliver (MV or SB) (%) 0
Final kissing balloon inflation (%) 89
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
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Death (n) 0 0
Myocardial infarction
0 0
QMI (n)
0 0
Non-QMI (n) 2* 0
TLR/TVR (n)
0 0
Scaffold dislodgement (n)
0 0
Scaffold Thrombosis (n) 0 0
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Eastern Heart Clinic/Prince of Wales Hospital Bifurcation Experience with BRS
n=52 )�� ��#��C+Death (n) 0
Cardiac Death (n) 0
Myocardial infarction 1
TLR/TVR n, (%) 1(1.9)
MACE n, (%) 2(3.8)
Scaffold Thrombosis (n) 0
CVA (n) 0
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Australian Real-World BRS Experience in Bifurcations
Conclusions
♥ Treatment of bifurcations with Absorb BRS is technically feasible
♥ Excellent device and procedural success in a variety of bifurcations (provisional and systematic two stent strategies)
♥ Very high safety and efficacy both in-hospital and in follow-up in “real-
world” bifurcations associated with long lesions, chronic total occlusions, calcification, and multi-vessel disease
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Australian Real-World BRS Experience in Bifurcations Lessons Learnt
♥ Meticulous technique (sizing, preparation, post-dilatation)
♥ Prolonged DAPT
♥ Liberal OCT use
♥ Bench modeling and trial results required
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Procedural Details (1)
Eastern Heart Clinic/Prince of Wales Hospital Real-World BRS Experience
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4% 1%
263 procedures/247 patients
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Procedural Details (3)
Eastern Heart Clinic/Prince of Wales Hospital Real-World BRS Experience
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Pre-dilatation (%) 100
Scaffold overlap (%) 32
Multi-vessel BVS (%) 15
Total scaffolds (%) 421
Scaffolds/patient (n/range) 1.7 (1-5)
OCT/IVUS use (%) 13
Rotablator/scoring balloon (%) 5
NC balloon post-dilatation (%) 99
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Procedural Details (4)
Eastern Heart Clinic/Prince of Wales Hospital Real-World BRS Experience
��Bivalirudin (%) 19
Unfractionated heparin (%) 81
Aspirin (%) 100
Clopidogrel (%) 64
Prasugrel (%) 35
Ticagrelor (%) 1