1. AIM-RADIAL
New York City
September 27, 2013
Josiah N. Wilcox, Ph.D.
Chief Scientific Officer
Coronary and RDN
Medtronic CardioVascular

2. Disclosures
• Full time employee of Medtronic CardioVascular
• I will be talking about experimental DES and
devices for RDN that are under investigation and
not currently approved for clinical use.

3. Collaborating with
Physicians to Develop
Life-Changing
Therapies

4. Global Leader in Medical Technology
46,000+
employees, making us the largest
global medical technology company
5,800+
scientists and engineers
around the world
1,500+
FY13 patents awarded, bringing our
total worldwide to more than 28,000
$16.6B
FY13 global sales from continuing
operations which generate $3.9B
in free cash flow*
~45%
* Free cash flow is operating cash flow minus capital expenditures
sales from international markets,
representing more than 140 countries

5. Diverse Revenue Sources
Cardiac Rhythm
Disease Management
Coronary
11%
30%
Structural
Heart
7%
Endovascular Therapies
5%
Surgical
Technologies
Diabetes
9%
9%
Neuromodulation
11%
Spine
19%
Based on FY2013 revenues of $16.6 billion. The data in this schedule has been intentionally rounded to the nearest
whole percentage and therefore does not sum to 100%.

6. Hospital management faced with need
to improve efficiency
European Market Research 2012; 59 C-Suite members in 34 hospitals
Pressure on budgets
•
Economic crisis impacts
health care & hospital
management
•
Budgets closely
monitored
by government / payer
•
Evaluate current system
& find new ways to attract
resources
Increased expectations
• From patients to get
best care
• From Medical professionals
to get access to latest treatment
options & develop of personal
career
• Government & Public monitor
quality of care

7. Towards Healthcare Solution Provider

8. Medtronic buys Cardiocom, Expands Into Disease Management
Wall Street Journal-Online August 11, 2013
Medtronic Inc. said it has acquired Cardiocom LLC, a closely held disease-management and patientmonitoring firm, in a move that the device maker hopes will turn increasing concerns about health spending to
its advantage.
The $200 million, all-cash deal puts Medtronic in the business of working with hospitals and insurers to limit
the costs of treating patients with chronic diseases, such as heart failure and diabetes, and gives it a hand in
the care of patients who don't need costly, high-tech implantable devices that are Medtronic's core offerings.
Heart Failure
Hypertension
Initial MDT Focus
Simple
Monitoring
Devices
CAD
Enterprise
Software
Nurse Call
Center
Diabetes
Pain

9. Strategies to Address Healthcare Needs
Universal
Healthcare Needs
Strategies
New Therapies Develop new therapies and technologies
Improve clinical
outcomes
to address unmet clinical needs and
drive them to standard of care
Globalization
Expand access
Optimize cost
and efficiency
Develop tailored solutions to address
market-specific needs and expand
access in global markets
Economic Value Translate the clinical value of therapies,
programs and services into economic
benefits for the health care system

10. Economic Value Framework
IMPROVE
OUTCOMES
EXPAND
ACCESS
OPTIMIZE
COST &
EFFICIENCIES
• Quality of clinical
evidence
• Treatment
guidelines
• Quality of clinical
evidence
• Quality measures
• Readmissions
• Quality of clinical
evidence (HTA)
• Reduced
complications
• Physician
reimbursement
• Ease of use
• Financial performance • Patient satisfaction
• Reputation/Competitive• Physician support
advantage
• Patient
satisfaction
• Invasiveness
• Procedure
efficiency
• Procedure efficiency
• Device price
• Affordability
/Liquidity
• Cost effectiveness
• Budget impact
• Quality of Life
• Mortality benefit

11. Integrity™ and Resolute Integrity™
A New Standard in Stent Design and Manufacturing
Conventional Stent Design
Medtronic Modular Design
Vs.
Slotted Tube
Modular Design
Medtronic’s Continuous Sinusoid Technology
Sinusoidal Formed Wire
Helical Wrap
Laser Fused

12. Stent Design
Integrity Platform
Continuous Flexibility Due to Unique Sinusoidal Design
DES
“Box car” or coupler
Continuous sinusoid
115° bend
Sinusoidal-formed wire
Helical wrap
Laser-fused

13. Resolute Integrity DES Deliverability
Superior Deliverability*
100
90
Average Push Force (gf)
Lower is Better
86
80
70
60
69
50
40
30
20
20
10
0
Promus Element DES
2.50 mm x 20 mm
Xience Prime DES
2.50 mm x 18 mm
DES
* Based on 3D tracking bench test data on file at Medtronic, Inc.
Resolute Integrity DES
2.50 mm x 18 mm

14. Resolute™ DES Resulted in 6% Fewer Stents per Patient
For a hospital performing 1,000 DES cases a
in a Large Real-World Trial vs. Xience V™ DES
year, the 6% reduction results in 116 fewer stents
and $174,000 Stents per product savings.
# in direct Patient
2.5
6% Fewer Stents p=0.02
# of Stents per Patient
2.0
2.02
1.9
1.5
1.0
p = 0.02
0.5
0
Resolute DES Xience V DES
Resolute™ DES
Xience V™ DES
n=1152
n=1140
n = 1140
n = 1152
• Large, international, randomized controlled trial in real-world patient population
• Similar patient populations, baseline demographics and lesion characteristics
* Results
from RESOLUTE All Comers trial. Serruys et al. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med. 2010;363:136-146.

15. Unique Continuous Sinusoid Technology
Enables New Stent Constructions
Continuous
Sinusoid
Technology
Conventional
Stent Design
Uniform Cross-Section
Wire
Resolute
Integrity
TM
Core Wire
Core Wire, Decore,
and Hole Drilling
Core Wire Stent
Drug Filled Stent
New Alloys
Metal
Bioabsorbable

16. Symplicity™ System Designed
Specifically for RDN
Symplicity™ Catheter:
• 6 F compatible
• Designed for safe, targeted therapy
delivery
• Self-orienting tip for confident, atraumatic
vessel contact
Symplicity™ Generator:
• Sophisticated automatic control
mechanisms to maximize safety
• Constantly adjusts therapy based on
feedback from the catheter tip
• Capable of adjusting therapy within 0.001
sec based on feedback
• Hands-free pedal activation

17. Symplicity Spyral™ Multi-Electrode
Renal Denervation Catheter
Design Goal
Reduce procedural time while maintaining similar clinical
outcomes and reassurance of success compared to original and
proven Symplicity Flex™ Catheter
Symplicity
Spyral Product
Features






1 minute ablation cycle
4 electrodes, independently selectable
6F guide catheter compatible
Non-occlusive
Natural conformability
Rapid exchange

18. Cost/QALY Comparison
Threshold
$50k
Geisler, B.P. et al. JACC 60(1271)2012

19. Transradial Economic Value
Average Savings per PCI ($550-$830)
~12% due to bleeding risk
~50% due to shorter length of stay (0.3-0.38 day)
US hospitals have potentially saved
$90 million annually by moving from
2% to 20% TRA adoption
1800
High Bleeding Risk
Adjusted Cost Savings per Procedure
1600
In Procedure Costs
1400
Post-Procedure Costs
1200
1000
$1,621
800
600
$1,046
400
$705
$571
200
0
-200
($17)
Average
Opportunities for Medtronic
$130
High Risk
Premier Database (2004-9)
Average
High Risk
5 Center US Study (2010-11)
1. Partner to develop training programs
and share best practices
2. Develop products to further increase
procedural success
Premier Database: n=609 TRA, 60,900 TFA; AmHeartJ (2013)
5 Center US Study: n=1,219 TRA, 5,902 TFA; JACC-CardioInt (2013)
US TRA rates were estimated at 2% in 2009 and 20% in 2013 Circulation (2013)

20. Global healthcare trends are driving increased
adoption of transradial access
90%
Anticipated Transradial Penetration*
80%
70%
60%
United States
50%
WECA
China
40%
India
30%
Japan
ROW
20%
10%
0%
FY11
FY12
FY13
FY14
FY15
FY16
FY17
FY18
FY19
Strategic opportunity for Medtronic to expand access,
improve outcomes, and increase efficiencies
* Internal Analysis

21. Facilitating Transradial Adoption
Clinical Education:
Patient Education:
Hospital Marketing Tools:
Proctorships, Preceptorships, &
Training Modules
Treatment Options
Awareness Campaigns

22. Transradial PCI Program Portfolio
Multi-tiered, targeted approach across learning spectrum
•
Speaker programs that facilitate peer-to-peer interaction
on the transradial approach and support the continual
improvement of patient care
•
Comprehensive curriculum developed for Interventional
Cardiology nurses and technicians
1 credit offered for TRA
MFE
CEU
•
•
Medtronic-sponsored summits that focus on didactic
presentations covering all the aspects of the transradial
procedure
•
Provides a group of 3-4 attendees with opportunity to
travel to a transradial clinical expert’s cath lab/institution
and have them observe him/her in clinic for one day
•
Provides a cath lab/institution with an opportunity to host
and work with a transradial clinical expert for a day in their
own facilities
TRA Summits
Preceptorship
Proctorship
22

23. A commitment to Transradial Education
•
•
•
•
•
Supported over 10 national summits in the past three years
• Over 500 physicians trained
Completed over 50 preceptorship/proctorship programs
• Over 1400 physicians trained
Medtronic Faculty Educators – 40% of speakers are dedicated to transradial
• 160 events per year
• Average of 8 physicians per event
• Over 1200 physicians trained
Cath Lab Manager Summit
• Over 300 managers trained in the past year
Over 3000 physicans/staff trained in the past year!!
23

24. All Part of Comprehensive Program Suite
Clinical Training
& Support
Transradial
CEU
Programs
Healthcare
Economic Services
Health Economics
Policy Updates
Case &
Payment
Reviews
Fellows
Training
Reimbursement &
Coding Education
Medtronic
Faculty
Educators
Outreach &
Patient Education
Peer-to-Peer
Engagement
CV
Executive
Summits*
Patient &
Physician
Outreach
Programs*
Cath Lab
Manager
Summits*
Disease
Management
& Disparities
Education
Cath Lab
Champions
Benchmark
Data
Patient Education
“Kit,” w/ DAPT Info
LIFELINE
Technical
Hotline
24

25. Products and Therapies
Develop new therapies and technologies
to address unmet clinical needs and drive
them to standard of care
Launcher Guide Catheters
• Large lumens with no performance
tradeoffs
• Flexible distal segment to engage
the guide for backup
• Supportive secondary curve
Sherpa NX Guide Catheters
• Two distal segments to provide options for guide
engagement
• Soft tip and distal sleeve to facilitate ease of
engagement
• Advanced HDPE liner for smooth, low-friction
device passage

26. Guide Catheter Lines
Unique Full-Wall Technology
Inner and outer jackets
encapsulate flat braid
wires, affording thinner,
stronger, walls.
Optimizes balance
between large lumen and
robust performance.
Dedicated Radial Curves
Designed to provide backup support and easy
engagement.

27. Many New Opportunities to Consider
Micropuncture access
Closure bands
Sheathless guides
Guide catheters
Arm supports
Peripheral procedures
Diagnostic catheters
Renal denervation procedures
Embolic protection
CTO solutions
Rx support catheters
Wires and balloons

28. Thank You