Jeffrey J. Popma, MD Director, Interventional Cardiology

1. Jeffrey J. Popma, MD Director, Interventional Cardiology Brigham and Womens Hospital Associate Professor of Medicine Harvard Medical School Boston, MA TAXUS Myonecrosis and sidebranch patency concerns are short-term issues with no long-term consequences, and the benefits are undeniable

2. New Insights into Periprocedural MI, Multiple Stents and Sidebranches

Distal platelet embolization was felt to be a major component of myonecrosis during PCI.GPIIb-IIIa inhibitors reduced this risk

Differential cardiac enzyme elevation was noted in the Taxus 5 Trial in patients treated with multiple stents, leading to a re-examination of the root cause of this event

3. Multiple Overlap Stenting in TAXUS V All Patients (n=1156) Multiple Stents inTarget Vessel (n=379) Planned Procedures (n=248) Emergent Procedures (n=78) QCA-confirmed Overlapping Stents (n=326) Received no stents (n=8) Single Stents (n=769) Planned Procedures (n=281) Emergent Procedures (n=98) No overlap(n=53) 4. Objective:Multiple Stent Analysis

TAXUS V Multiple Stent Patients:

62.7% Lesions >26mm

86.0% QCA-confirmed overlapping stents

44.0% 2.25 and 2.5 mm stents

34.3% Patients with diabetes

73.1% Type C lesions

5. MACE in QCA Analysis Subgroup 0.08 8.7% 3.9% MI 0.0027 16.3% 29.8% TVR 1.00 0.5% 0.6% Cardiac Death 0.0172 20.7% 32.0% 9-Month MACE 0.5% 3.3% 0.0% 3.3%Controln=184 0.62 1.6% TVR 0.0457 8.6% MI 0.0% Cardiac Death 0.0457 8.6% 30-Day MACE P value TAXUS n=188 6. TAXUS V Multiple Stent Analysis Methodology

Blinded core lab analysis of all multiple stent patients

Main Vessel Analysis:

Main vessel No Reflow, TIMI flow, Dissection,Distal Embolization, Abrupt Closure

Side Branch Analysis (for branches >1 mm):

Branch occlusion (total occlusion)

Branch narrowing ( 70%100%)

Branch TIMI flow

7. Side Branch Analysis in Multiple Stenting Sidebranch Occlusion TIMI Flow Reduction Side Branch Narrowing( 70%100%) 8. Main Vessel Analysis in Multiple Stenting Peri-procedural Ischemic Complicatons 0.50 3.2 1.6 Final (%) 1.00 7.4 7.6 Transient (%) No Reflow - 0.0 0.0 Final (%) 0.28 3.2 1.1 Transient (%) TIMI Flow - 0.0 0.0 Final (%) 0.62 1.6 0.5 Transient (%) Abrupt Closure Controln=184 pts P value TAXUS n=188 pts 9. Side Branch Analysis in Multiple Stenting 0.74 89.1 87.5 % pts with Sidebranch 289 268 Total Sidebranches (n) 0.45 1.42 0.371.40 0.36Sidebranch RVD (mm) 0.55 1.66 0.991.60 1.01# Branches (per pt.) Controln=184 pts P value TAXUS n=188 pts 10. Side Branch Analysis in Multiple Stenting TIMI Flow: Timing, Any Time Point Timeline Control (n=263) TAXUS (n=285) Baseline 1.5% 2.5% p=0.55 After Pre- Dilatation 3.8% 6.3% p=0.24 After FirstStent 10.3% 15.1% p=0.10 After Additional Stent(s) 12.9% 20.7% p=0.02 After Post- Dilatation 12.9% 22.1% p=0.05 11. Impact of the Overlap Region (per side branch) Any Sidebranch Occlusion Any Sidebranch Narrowing Any TIMI Flow Reduction Control TAXUS 37/203 34/207 8/48 15/55 51/203 68/207 12/48 26/55 56/203 58/207 21/48 24/55 Non-overlap region Overlap region Non-overlap region Overlap region Non-overlap region Overlap region p=0.74 p=0.23 p=0.10 p=0.025 p=1.00 p=1.00 12. Non-Q-Wave MI in Multiple Stent Patients: Transient Side Branch Compromise 28.6% 41.9% (65/155) Side Branch (42/147) P=0.0164 MI 3.3% 8.3% 30 Days Taxus N=193 Control N=184 (6/184) (16/193) P=0.0472 1.1% (2/184) Main Branch (6/188) 3.2% P=0.284 3.9% (7/181) (16/191) 8.4% P=0.0858 MI 9 Months 17.7% (25/155) (26/147) 16.1% P=0.760 TIMI Flow Reduction Side Branch 62% decrease 38% decrease Peri-procedure TIMI Flow reduction 13. Possible Causes of Sidebranch Compromise