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SIRIUS: Purpose ,[object Object],[object Object]
SIRIUS Study design
SIRIUS: Endpoints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SIRIUS: Study Design ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SIRIUS: Study Design De Novo  Coronary Lesions  Diameter: 2.5-3.5 mm Length: 15-30 mm Control  Bx VELOCITY TM n = 556 CYPHER TM n = 545 n = 1101 patients Angiographic Sub-study:  first 850 pts (FU at 8 months)  IVUS Substudy:  250 pts at selected sites (FU at 8 months)
SIRIUS: Pharmacologic Regimen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],}   >  24hrs }   3 months
SIRIUS: Inclusion Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],*  Visual estimate
SIRIUS: Exclusion Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SIRIUS: Study Procedure n = 1100 pts Single  de novo  native coronary lesion Pre-dilation (balloons only) Post-dilation (high pressure balloons) Bx –  Sirolimus vs. non-coated
SIRIUS: Study Flow All Randomised Patients n = 1101 CYPHER n = 533 Control  Bx VELOCITY TM n = 525 Angio FU at 8 Months = 85.4% Clinical FU at 9 Months = 95.7% Angio FU at 8 Months = 84.7% Clinical FU at 9 Months = 95.8% De-registered CYPHER (n=23) De-registered Control Bx VELOCITY TM (n=20)
SIRIUS: Patient Demographics 32.9 28.2 Prior MI 23.1 26.3 Prior PCI 22.4 17.7 Current Smoker 67.8 67.6 Hypertension 74.6 72.6 Hyperlipidaemia 28.2 24.6 Diabetes Mellitus 62.4 62.1 Mean age (years) 69.7 72.6 Male Control (%) (n=525) CYPHER   (%) (n=533)
SIRIUS: Baseline Lesion Characteristics 32.4 30.0 RCA 0.6 0.6 Other 20.6 26.0 C 33.5 32.6 B2 38.1 34.0 B1 7.8 7.4 AHA/ACC  A 23.9 25.3 LCx 43.2 44.2 LAD Control (%) (n=525) CYPHER   (%) (n=533)
SIRIUS: Baseline Lesion Characteristics (2) 13.7 15.4 3 14.4  ±  5.8 14.4  ±  5.7 Mean Lesion length 13.4 15.2 >20mm 66.2 64.8 10-20mm 20.4 20.0 Lesion length  <10mm 28.8 25.3 2 57.5 59.3 No. of diseased coronaries  1 Control (%) (n=525) CYPHER   (%) (n=533)
SIRIUS: Stents Implanted 26.9 28.5 Patients with overlapping stents 1.4  ± 0.6 1.4  ± 0.7 Mean stents per patient (n) 21.2  ± 6.8 21.5  ± 6.7 Stent length (mm) 0.8 1.5    4 4.6 4.9 3 29.5 28.6 2 37.0 35.1 3.5 64.9 65.0 Number of stents per patient  1 45.8 45.6 3.0 17.2 19.3 Diameter  2.5 Control (%) CYPHER   (%)
SIRIUS: Other Procedural 59.2 60.4 IIbIIIa during procedures (%) 1.2  ± 0.6 1.2  ± 0.9 Mean hospital stay (days) Control CYPHER
SIRIUS: Control Group ,[object Object],[object Object]
SIRIUS:  QCA  Definitions ,[object Object],[object Object],5 mm 5 mm 5 mm In-segment in-stent proximal distal
SIRIUS: QCA Late Loss Analysis   (9-month) Margins = 5mm either side of stent P < 0.001 P < 0.001 P < 0.001
SIRIUS  12 -month Results
SIRIUS: Clinical events (all events to 360 days) Events 24.8 (130) 22.3 (117) 6.7 (35) 1.3 (7) 5.5 (29) 19.2 (101) 3.0 (16) 20.0 (105) 1.7 (9) 3.4 (18) 0.8 (4) Control % n = 525 0.449 <0.001 0.295 2.3 (12) 4.9 (26) 0.9 (5) Non Q-wave TLR TLR-CABG <0.001 4.3 (23) TLR-PCI <0.001 9.8 (52) TVF <0.001 8.3 (44) MACE <0.001 3.6 (19) 0.6 (3) 3.2 (17) TVR (non TLR) TVR-CABG TVR-PCI 0.723 3.0 (16) MI (all) 0.547 1.3 (7) Death P-value CYPHER % n = 533
SIRIUS: Clinical events (diabetics only to 360 days) Note that TLR & TVR rates are  clinically driven only  and do not include angiographically driven procedures Events 29.1 (43) 8.1 (12) 0.0 (0) 8.1 (12) 25.0 (37) 4.1 (6) 26.4 (39) 2.0 (3) 4.1 (6) 0.7 (1) Control % n = 148 1.5 (2) 8.4 (11) 0.8 (1) Non Q-wave TLR TLR-CABG 8.4 (11) TLR-PCI 11.5 (15) MACE 5.3 (7) 0.0 (0) 5.3 (7) TVR (non TLR) TVR-CABG TVR-PCI 2.3 (3) MI (all) 1.5 (2) Death CYPHER % n = 131
Reduction in TLR by Patient Characteristics Lesion Length Reference Vessel Diameter 72.8 74.8 76.5 75.3 76.6 77.6 12mm - 15mm 75.7 77.0 2.5mm < RVD < 3.0mm 74.1 75.9 RVD < 2.5mm 70.8 73.8 RVD < 2.5mm 73.4 75.5 2.5mm < RVD < 3.0mm 75.6 76.9 RVD > 3.0mm Diabetics 77.0 77.8 RVD > 3.0mm Non-Diabetics > 15mm < 12mm
CP1104360-1 Freedom from events (%) Post  procedure (days) Cypher  TLR Control TLR Cypher  MACE Control MACE Cypher  TVF Control TVF Event-free survival at 1 year for TLR, MACE & TVF
SIRIUS: TLR Events Overall 4. 9 20.0 0.0001 1 5 2 M ale 5.2 20.5 0.0001 1 53 Female 4 .1 1 9.0 0.000 2 1 49 Diabetes 8 . 4 2 6.4 0.000 2 1 80 No Diabetes 3. 7 1 7.6 0.0001 1 38 LAD 6 . 0 23.0 0.0001 17 0 Non-LAD 4 .1 18.0 0.0001 1 4 0 Small Vessel  (<2.75) 6. 6 22 . 3 0.0001 15 7 Large Vessel 3.1 18.2 0.0001 1 51 Short Lesion 4.0 1 8.6 0.0001 1 46 Long Lesion  (>13.5) 6.0 2 1 .9 0.0001 1 58 Overlap 5 .7 23 . 2 0.000 1 1 75 No Overlap 4.5 1 8.6 0.0001 1 4 1 Hazards Ratio 95% CI 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0.7 0.8 0.9 CYPHER Control P-value CYPHER better # events  prevented per 1,000 patients
SIRIUS: Stent Thrombosis * 234 days post-procedure ** 40, 150 and 181 days post-procedure 0 0 Acute (   24 hours) 0.8 (4) 0.6 (3)** 0.2 (1) Control n=525  %  (n) 0.4 (2) Total 0.2 (1)* Late (31- 36 0 days) 0.2 (1) Sub-acute (1-30 days) CYPHER n=533  %  (n)
SIRIUS:  12 -month summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Cypher Stent - SIRIUS Trial

  • 1.  
  • 2.
  • 4.
  • 5.
  • 6. SIRIUS: Study Design De Novo Coronary Lesions Diameter: 2.5-3.5 mm Length: 15-30 mm Control Bx VELOCITY TM n = 556 CYPHER TM n = 545 n = 1101 patients Angiographic Sub-study: first 850 pts (FU at 8 months) IVUS Substudy: 250 pts at selected sites (FU at 8 months)
  • 7.
  • 8.
  • 9.
  • 10. SIRIUS: Study Procedure n = 1100 pts Single de novo native coronary lesion Pre-dilation (balloons only) Post-dilation (high pressure balloons) Bx – Sirolimus vs. non-coated
  • 11. SIRIUS: Study Flow All Randomised Patients n = 1101 CYPHER n = 533 Control Bx VELOCITY TM n = 525 Angio FU at 8 Months = 85.4% Clinical FU at 9 Months = 95.7% Angio FU at 8 Months = 84.7% Clinical FU at 9 Months = 95.8% De-registered CYPHER (n=23) De-registered Control Bx VELOCITY TM (n=20)
  • 12. SIRIUS: Patient Demographics 32.9 28.2 Prior MI 23.1 26.3 Prior PCI 22.4 17.7 Current Smoker 67.8 67.6 Hypertension 74.6 72.6 Hyperlipidaemia 28.2 24.6 Diabetes Mellitus 62.4 62.1 Mean age (years) 69.7 72.6 Male Control (%) (n=525) CYPHER (%) (n=533)
  • 13. SIRIUS: Baseline Lesion Characteristics 32.4 30.0 RCA 0.6 0.6 Other 20.6 26.0 C 33.5 32.6 B2 38.1 34.0 B1 7.8 7.4 AHA/ACC A 23.9 25.3 LCx 43.2 44.2 LAD Control (%) (n=525) CYPHER (%) (n=533)
  • 14. SIRIUS: Baseline Lesion Characteristics (2) 13.7 15.4 3 14.4 ± 5.8 14.4 ± 5.7 Mean Lesion length 13.4 15.2 >20mm 66.2 64.8 10-20mm 20.4 20.0 Lesion length <10mm 28.8 25.3 2 57.5 59.3 No. of diseased coronaries 1 Control (%) (n=525) CYPHER (%) (n=533)
  • 15. SIRIUS: Stents Implanted 26.9 28.5 Patients with overlapping stents 1.4 ± 0.6 1.4 ± 0.7 Mean stents per patient (n) 21.2 ± 6.8 21.5 ± 6.7 Stent length (mm) 0.8 1.5  4 4.6 4.9 3 29.5 28.6 2 37.0 35.1 3.5 64.9 65.0 Number of stents per patient 1 45.8 45.6 3.0 17.2 19.3 Diameter 2.5 Control (%) CYPHER (%)
  • 16. SIRIUS: Other Procedural 59.2 60.4 IIbIIIa during procedures (%) 1.2 ± 0.6 1.2 ± 0.9 Mean hospital stay (days) Control CYPHER
  • 17.
  • 18.
  • 19. SIRIUS: QCA Late Loss Analysis (9-month) Margins = 5mm either side of stent P < 0.001 P < 0.001 P < 0.001
  • 20. SIRIUS 12 -month Results
  • 21. SIRIUS: Clinical events (all events to 360 days) Events 24.8 (130) 22.3 (117) 6.7 (35) 1.3 (7) 5.5 (29) 19.2 (101) 3.0 (16) 20.0 (105) 1.7 (9) 3.4 (18) 0.8 (4) Control % n = 525 0.449 <0.001 0.295 2.3 (12) 4.9 (26) 0.9 (5) Non Q-wave TLR TLR-CABG <0.001 4.3 (23) TLR-PCI <0.001 9.8 (52) TVF <0.001 8.3 (44) MACE <0.001 3.6 (19) 0.6 (3) 3.2 (17) TVR (non TLR) TVR-CABG TVR-PCI 0.723 3.0 (16) MI (all) 0.547 1.3 (7) Death P-value CYPHER % n = 533
  • 22. SIRIUS: Clinical events (diabetics only to 360 days) Note that TLR & TVR rates are clinically driven only and do not include angiographically driven procedures Events 29.1 (43) 8.1 (12) 0.0 (0) 8.1 (12) 25.0 (37) 4.1 (6) 26.4 (39) 2.0 (3) 4.1 (6) 0.7 (1) Control % n = 148 1.5 (2) 8.4 (11) 0.8 (1) Non Q-wave TLR TLR-CABG 8.4 (11) TLR-PCI 11.5 (15) MACE 5.3 (7) 0.0 (0) 5.3 (7) TVR (non TLR) TVR-CABG TVR-PCI 2.3 (3) MI (all) 1.5 (2) Death CYPHER % n = 131
  • 23. Reduction in TLR by Patient Characteristics Lesion Length Reference Vessel Diameter 72.8 74.8 76.5 75.3 76.6 77.6 12mm - 15mm 75.7 77.0 2.5mm < RVD < 3.0mm 74.1 75.9 RVD < 2.5mm 70.8 73.8 RVD < 2.5mm 73.4 75.5 2.5mm < RVD < 3.0mm 75.6 76.9 RVD > 3.0mm Diabetics 77.0 77.8 RVD > 3.0mm Non-Diabetics > 15mm < 12mm
  • 24. CP1104360-1 Freedom from events (%) Post procedure (days) Cypher TLR Control TLR Cypher MACE Control MACE Cypher TVF Control TVF Event-free survival at 1 year for TLR, MACE & TVF
  • 25. SIRIUS: TLR Events Overall 4. 9 20.0 0.0001 1 5 2 M ale 5.2 20.5 0.0001 1 53 Female 4 .1 1 9.0 0.000 2 1 49 Diabetes 8 . 4 2 6.4 0.000 2 1 80 No Diabetes 3. 7 1 7.6 0.0001 1 38 LAD 6 . 0 23.0 0.0001 17 0 Non-LAD 4 .1 18.0 0.0001 1 4 0 Small Vessel (<2.75) 6. 6 22 . 3 0.0001 15 7 Large Vessel 3.1 18.2 0.0001 1 51 Short Lesion 4.0 1 8.6 0.0001 1 46 Long Lesion (>13.5) 6.0 2 1 .9 0.0001 1 58 Overlap 5 .7 23 . 2 0.000 1 1 75 No Overlap 4.5 1 8.6 0.0001 1 4 1 Hazards Ratio 95% CI 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0.7 0.8 0.9 CYPHER Control P-value CYPHER better # events prevented per 1,000 patients
  • 26. SIRIUS: Stent Thrombosis * 234 days post-procedure ** 40, 150 and 181 days post-procedure 0 0 Acute (  24 hours) 0.8 (4) 0.6 (3)** 0.2 (1) Control n=525 % (n) 0.4 (2) Total 0.2 (1)* Late (31- 36 0 days) 0.2 (1) Sub-acute (1-30 days) CYPHER n=533 % (n)
  • 27.

Editor's Notes

  1. This is a Holding slide