DRUG ELUTING STENT FOR DIABETIC PATIENTS IN CORONARY ARTERY DISEASE TREATMENT
DRUG ELUTING STENT FOR DIABETIC PATIENTS IN CORONARY ARTERY DISEASE TREATMENT
Study Title A post market registry of Abluminus® sirolimus eluting coronary stent system for
 percutaneous intervention in patients with diabetes mellitus Purpose The purpose of this
 registry is to prospectively capture clinical data of ABLUMINUS® sirolimus eluting stent in
 patients with Diabetes Mellitus.

 Investigational Device ABLUMINUS® sirolimus eluting stent consists of four components; a bare
 metal stent (BMS), a delivery system, the bio absorbable polymer delivery matrix and
 Abluminal surface coating on stent and parts of balloon in Pre-crimped condition the
 anti-proliferative drug, Sirolimus.

 Study Design Prospective, Observational, Multi-center registry Estimated Enrolment 1000
 patients

 End points Primary Endpoints:

 Target Lesion Failure that is composite of cardiac death, target-vessel myocardial
 infarction, and clinically indicated target lesion revascularisation within 12 months.

 Components of the primary end point are defined as follows:

 -  Cardiac Death: any death due to immediate cardiac cause, deaths related to the
 procedure, unwitnessed death, and death of unknown cause.

 -  Target Vessel Myocardial infarction: categorised according to the Minnesota
 electrocardiographic criteria (Q-wave and non-Q-wave). Spontaneous myocardial infarction
 was defined as a typical rise and fall of creatinine kinase-MB fraction or troponin in
 the presence of at least one of several conditions: ischaemic symptoms, new pathological
 Q waves, ischaemic electrocardiographic changes, or pathological evidence of acute
 myocardial infarction. Peri-procedural myocardial infarction was defined as an increase
 in creatinine kinase to more than twice the normal value with increased values of
 confirmatory biomarkers (creatinine kinase-MB fraction or troponin higher than usual).
 Target-vessel-related myocardial infarction was one related to the target vessel or that
 could not be clearly related to another vessel.

 -  Target Lesion Revascularisation: any repeat percutaneous or surgical intervention due to
 a stenosis or occlusion within the device of the index procedure.

 Secondary Endpoints

 -  Stent thrombosis [Time Frame: 1 month, 12 months, yearly]. Definite and probable stent
 thrombosis according to ARC definitions;

 -  Cardiac death [Time Frame: 1 month, 12 months, yearly]

 -  Target Vessel Myocardial infarction [Time Frame: 1 month, 12 months, yearly]

 -  Target Lesion Revascularisation [Time Frame: 1 month, 12 months, yearly]

 -  Device Success at 24 hours

 -  Lesion Success at 24 hours

 -  Procedural Success at 24 hours Eligibility Eligible Age: 18 Years and older. Eligible
 Genders: Both. Inclusion Criteria

 -  The patient must be at least 18 years of age.

 -  Diabetic patient having clinical evidence of myocardial ischemia (e.g., stable or
 unstable angina, silent ischemia or positive functional study; acute coronary syndromes
 will be considered).

 -  The patient is an acceptable candidate for percutaneous trans-luminal coronary
 angioplasty (PTCA) stenting and emergent coronary artery bypass graft (CABG) surgery.

 -  Culprit de novo lesion in a native coronary artery with significant stenosis (>50% by
 visual estimate) eligible for stent implantation (no limitation on the number of treated
 lesions, vessel and lesion length);

 -  Patients included are those for whom the physician has already considered worthwhile the
 use of Abluminus Stent according to the indications provided by the IFU;

 -  Patient provides written informed consent;

 -  Patient agrees to all required follow-up procedures and visits. Exclusion Criteria • The
 patient has a known hypersensitivity or contraindication to any of the following
 medications:Heparin, Aspirin, Both Clopidogrel and TIclopidine, Sirolimus, paclitaxel,
 ABT 578Stainless steel, Cobalt, biodegradable PLLA polymer.

 -  Patients with hypersensitivity to contrast media who cannot be treated with adequate
 prophylaxis.

 -  Female of childbearing potential, unless a recent pregnancy test is negative, who
 possibly plan to become pregnant any time after enrolment into this study.

 -  Patients who are actively participating in another drug or device investigational study,
 which have not completed the primary endpoint follow-up period.

 -  History of bleeding diathesis or known coagulopathy (including heparin-induced
 thrombocytopenia), or will refuse blood transfusions

 -  Previous coronary intervention on target vessel.

 -  Non-cardiac co-morbid conditions with life expectancy <1 year or that may result in
 protocol non-compliance (per site investigator's medical judgment).

 -  Lesions not allowing a complete balloon inflation or stent deployment. Clinical Follow
 up At Discharge, 1 month, 6 months, 12 months, yearly.
DEDICATE Registry:

 DRUG ELUTING STENT FOR DIABETIC PATIENTS IN CORONARY ARTERY DISEASE TREATMENT

 A POST MARKET REGISTRY OF ABLUMINUS® SIROLIMUS ELUTING CORONARY STENT SYSTEM FOR PERCUTANEOUS
 INTERVENTION IN PATIENTS WITH DIABETES MELLITUS

 Version 1.0

 Principal Investigator Dr. Luca Testa, MD, PhD Head of Coronary Revascularization Unit Head
 of Clinical Research Unit Department of Cardiology, IRCCS Policlinico S. Donato, San Donato
 M.ne, Milan, Italy Email: luctes@gmail.com

 Chairperson Dr. Francesco Bedogni, MD Head of Cardiology IRCCS Policlinico S. Donato, San
 Donato M.ne, Milan, Italy

 Protocol Signature Page

 Principal Investigator (Coordinator Center)

 Investigate site IRCCS Policlinico San Donato

 Name Dr. Luca Testa

 Signature ______________________

 Date _____________________

 Chairperson (Coordinator Center)

 Investigate site IRCCS Policlinico San Donato

 Name Dr. Francesco Bedogni

 Signature ______________________

 Date _____________________

 Principal Investigator

 Investigate site ___________________

 Name __________________

 Signature ______________________

 Date _____________________

 Protocol summary

 Study Title A post market registry of Abluminus® sirolimus eluting coronary stent system for
 percutaneous intervention in patients with diabetes mellitus Purpose The purpose of this
 registry is to prospectively capture clinical data of ABLUMINUS® sirolimus eluting stent in
 patients with Diabetes Mellitus.

 Investigational Device ABLUMINUS® sirolimus eluting stent consists of four components; a bare
 metal stent (BMS), a delivery system, the bio absorbable polymer delivery matrix and
 Abluminal surface coating on stent and parts of balloon in Pre-crimped condition the
 anti-proliferative drug, Sirolimus.

 Study Design Prospective, Observational, Multi-center registry Estimated Enrolment 1000
 patients

 End points Primary Endpoints:

 Target Lesion Failure that is composite of cardiac death, target-vessel myocardial
 infarction, and clinically indicated target lesion revascularisation within 12 months.

 Components of the primary end point are defined as follows:

 -  Cardiac Death: any death due to immediate cardiac cause, deaths related to the
 procedure, unwitnessed death, and death of unknown cause.

 -  Target Vessel Myocardial infarction: categorised according to the Minnesota
 electrocardiographic criteria (Q-wave and non-Q-wave). Spontaneous myocardial infarction
 was defined as a typical rise and fall of creatinine kinase-MB fraction or troponin in
 the presence of at least one of several conditions: ischaemic symptoms, new pathological
 Q waves, ischaemic electrocardiographic changes, or pathological evidence of acute
 myocardial infarction. Peri-procedural myocardial infarction was defined as an increase
 in creatinine kinase to more than twice the normal value with increased values of
 confirmatory biomarkers (creatinine kinase-MB fraction or troponin higher than usual).
 Target-vessel-related myocardial infarction was one related to the target vessel or that
 could not be clearly related to another vessel.

 -  Target Lesion Revascularisation: any repeat percutaneous or surgical intervention due to
 a stenosis or occlusion within the device of the index procedure.

 Secondary Endpoints

 -  Stent thrombosis [Time Frame: 1 month, 12 months, yearly]. Definite and probable stent
 thrombosis according to ARC definitions;

 -  Cardiac death [Time Frame: 1 month, 12 months, yearly]

 -  Target Vessel Myocardial infarction [Time Frame: 1 month, 12 months, yearly]

 -  Target Lesion Revascularisation [Time Frame: 1 month, 12 months, yearly]

 -  Device Success at 24 hours

 -  Lesion Success at 24 hours

 -  Procedural Success at 24 hours Eligibility Eligible Age: 18 Years and older. Eligible
 Genders: Both. Inclusion Criteria

 -  The patient must be at least 18 years of age.

 -  Diabetic patient having clinical evidence of myocardial ischemia (e.g., stable or
 unstable angina, silent ischemia or positive functional study; acute coronary syndromes
 will be considered).

 -  The patient is an acceptable candidate for percutaneous trans-luminal coronary
 angioplasty (PTCA) stenting and emergent coronary artery bypass graft (CABG) surgery.

 -  Culprit de novo lesion in a native coronary artery with significant stenosis (>50% by
 visual estimate) eligible for stent implantation (no limitation on the number of treated
 lesions, vessel and lesion length);

 -  Patients included are those for whom the physician has already considered worthwhile the
 use of Abluminus Stent according to the indications provided by the IFU;

 -  Patient provides written informed consent;

 -  Patient agrees to all required follow-up procedures and visits. Exclusion Criteria • The
 patient has a known hypersensitivity or contraindication to any of the following
 medications:Heparin, Aspirin, Both Clopidogrel and TIclopidine, Sirolimus, paclitaxel,
 ABT 578Stainless steel, Cobalt, biodegradable PLLA polymer.

 -  Patients with hypersensitivity to contrast media who cannot be treated with adequate
 prophylaxis.

 -  Female of childbearing potential, unless a recent pregnancy test is negative, who
 possibly plan to become pregnant any time after enrolment into this study.

 -  Patients who are actively participating in another drug or device investigational study,
 which have not completed the primary endpoint follow-up period.

 -  History of bleeding diathesis or known coagulopathy (including heparin-induced
 thrombocytopenia), or will refuse blood transfusions

 -  Previous coronary intervention on target vessel.

 -  Non-cardiac co-morbid conditions with life expectancy <1 year or that may result in
 protocol non-compliance (per site investigator's medical judgment).

 -  Lesions not allowing a complete balloon inflation or stent deployment. Clinical Follow
 up At Discharge, 1 month, 6 months, 12 months, yearly.

 CONTENTS

 1. BACKGROUND AND INTRODUCTION 7

 2. RISK ANALYSIS 9

 3. AIM OF THE REGISTRY 11

 4. REGISTRY DESIGN 11

 5. ENDPOINT 11

 6. REGISTRY POPULATION 12

 7. REGISTRY PROCEDURES 13

 8. ANTITHROMBOTIC TREATMENT 14

 9. FOLLOW-UP PERIOD 15

 10. SERIOUS ADVERSE EVENT REPORTING 15

 11. MACE ADJUDICATION 16

 12. STATISTICAL ANALYSIS 16

 13. QUALITY CONTROL AND ASSURANCE 16

 14. ETHICAL CONSIDERATION 17

 1. BACKGROUND AND INTRODUCTION

 Era of Percutaneous Coronary Intervention (PCI) started with plain old balloon
 angioplasty (POBA) and progressed to bare metal stent (BMS) and then to drug-eluting
 stent (DES). In DES, polymer was used in addition to the drug, so that it could hold the
 drug on the stent platform and could facilitate controlled drug release. Thus, drug and
 polymer became hallmark of DES [1].

 Current DES consist of a metal stent platform and a therapeutic agent, which is either
 directly immobilized on the stent surface or released from a polymer matrix. While
 drug-eluting stents without surface polymer are available, the reduction in angiographic
 and clinical restenosis is less potent and appears therefore less promising for clinical
 utilization. In contrast, polymer-based, drug-eluting stents allow for controlled
 release of therapeutic agents at the site of injury [2].

 The most effective drugs utilized with drug-eluting stents for prevention of restenosis
 up to this point in time have been Sirolimus and Paclitaxel. Both drugs are highly
 lipophilic and show rapid and strong uptake in arterial wall tissue. In addition,
 Sirolimus and paclitaxel have been shown to reduce smooth muscle cell proliferation and
 neo-intimal hyperplasia, the principal cause of restenosis after coronary stenting in
 experimental models. Sirolimus and Paclitaxel have the same effect on cells
 proliferation, but with a different mode of action.A recent meta-analysis of
 drug-eluting stent trials confirmed the reduction in restenosis and repeat
 revascularization procedures for polymer-based, drug-eluting stents. Moreover, the rates
 of death and myocardial infarction were comparable to those with bare-metal stents,
 attesting to the safety of these devices, which have been approved by the US Food and
 Drug Administration.

 Patients with diabetes mellitus referred for percutaneous coronary intervention (PCI)
 represent one of the greatest challenges for the interventional cardiologist. Restenosis
 continues to be the major limitation of PCI, particularly in patients with diabetes [2].
 Restenosis rates after balloon angioplasty in diabetic patients can be very high (up to
 63%), and although stenting has been shown to decrease these rates, diabetic patients
 continue to have significantly higher restenosis rates and clinical events following
 PCI. Slight elevations in fasting blood glucose levels, the need for insulin, and
 suboptimal blood glucose control may have a significant impact on the prognosis.
 Drug-eluting stents (DES) have been shown to have a considerably lower risk of
 restenosis and as a result, there is growing interest in using such stents to treat
 coronary lesions in complex scenarios. Sub studies carried out in diabetic patients from
 large clinical trials conducted with DES have found considerable decreases in the risk
 of restenosis and new revascularizations. [3,4] Nevertheless, despite the availability
 use of DES, diabetic patients show a higher risk than non-diabetics.Hyperinsulinemia and
 insulin resistance are implicated in a variety of molecular mechanisms that could
 predispose diabetics to a higher incidence of restenosis.

 The purpose of this registry is to capture clinical data of ABLUMINUS® sirolimus eluting
 stent in in real world, all come patients with Diabetes Mellitus.

 1.1 Device Description

 The device ABLUMINUS® Sirolimus eluting coronary stent integrates well known and
 accepted Sirolimus drug on the proven CYGNUS Cobalt chromium platform with biodegradable
 polymer matrix.

 The device ABLUMINUS® sirolimus eluting stent system has a combination of inactive and
 active component. The active component is Sirolimus drug. The inactive component is PLLA
 polymer (biodegradable polymer). The polymer-drug combination is applied solely to a
 unique abluminal coating technology known as "ënvisõlution™ Technology" which is a
 highly effective drug delivery technology with target specific coating in abluminal
 configuration on stent and parts of balloon. It also uses biodegradable polymer to
 achieve longer drug release.

 The stent platform is a thin strut (73 microns) of L605cobalt chromium stent with open
 and closed cell (hybrid) design, which provides good radial strength and side branch
 accessibility. The thin struts enhance the trackability and gives lower crossing profile
 to the device for navigating through difficult and tortuous lesions. The delivery system
 is a Rapid exchange (Rx) System.

 It is expected that ABLUMINUS® sirolimus eluting stent system will significantly reduce
 delay in healing and thrombosis events, while providing comparable results, regarding
 restenosis, to other DES systems on the market.

 1.2 Therapeutic Agent-Sirolimus Drug

 Sirolimus is a cytostatic drug used for treatment of various disease in Humans. The drug
 works on FKBP-12 protein and inhibits growth factor-simulated cell proliferation.
 Sirolimus forms a complex with FKBP Protein that inhibits the cell cycle between G0 and
 G1 phase. This results in interruption of the cascade governing cell growth, metabolism
 and proliferation.

 1.3 STENT PLATFORM ABLUMINUS® sirolimus eluting stent system is a combination product
 comprised of two key components: the Stent (which includes the active pharmaceutical
 ingredient (API) Sirolimus drug incorporated into a bio-degradable polymer coating), and
 delivery catheter. A balloon expandable L605 chromium cobalt stent with bio-degradable
 polymer coating containing Sirolimus drug is pre-mounted onto a highly deliverable
 semi-compliant rapid exchange delivery system. The delivery catheter has two radiopaque
 markers, which mark the ends of the stent to facilitate proper positioning and
 placement. The catheter has hydrophilic coating facilitating easy delivery of the
 system.

 The Stent has a biodegradable polymer matrix consisting of Poly L Lactic acid (PLLA)
 which has been wide spread application in medical devices. The Poly lactic acid, its
 co-polymers and mixtures have been evaluated in pre-clinical studies and clinical
 studies around the world, revealing favourable bio-compatibility profile. The
 bio-degradable polymer has been demonstrated to be safe when used as an implant or drug
 release-control polymer for both animal and humans.

 2. RISK ANALYSIS

 As with any patient undergoing percutaneous coronary intervention, subject in this
 registry may experience adverse events and/or outcomes that may include, but are not
 necessarily limited to the following:

 -  Abrupt stent closure or failure to expand the stent

 -  Abrupt vessel closure or spasm

 -  Acute myocardial infarction

 -  Allergic reaction to anti-coagulation and/or anti thrombotic therapy, contrast
 material, or stent and/or delivery system materials

 -  Aneurysm, pseudo aneurysm or arteriovenous fistula

 -  Arrhythmias, including ventricular fibrillation and ventricular tachycardia

 -  Cardiac tamponade

 -  Cardiogenic shock

 -  Death

 -  Dissection, perforation, or rupture of the coronary artery

 -  Emboli, distal (air, tissue or thrombic emboli)

 -  Emergency coronary artery bypass graft (CABG) as a result of damage to the stent /
 injury to the vessel

 -  Fever

 -  Hematoma at insertion site

 -  Haemorrhage requiring transfusion

 -  Hypotension/hypertension

 -  Infection and/or pain at site of insertion

 -  Late stent thrombosis/ stent thrombosis/ occlusion

 -  Perforation or rupture of artery

 -  Peripheral ischemia or peripheral nerve injury

 -  Stroke or transient ischemia attack

 -  Renal failure

 -  Restenosis of stented segment

 -  Stent migration or stent embolization

 -  Total occlusion of coronary artery

 -  Unstable angina

 Adverse events that may be associated with Sirolimus drug coating:

 -  Allergic/immunologic reaction to drug or stent coating

 -  Alopecia

 -  Anaemia

 -  Blood product transfusion

 -  Gastrointestinal symptoms

 -  Haematologicaldyscrasia (including leukopenia, neutropenia, thrombocytopenia)

 -  Hepatic enzyme changes

 -  Histological changes in vessel wall, including inflammation, cellular damage or
 necrosis

 -  Myalgia/Arthralgia

 -  Peripheral neuropathy

 Appropriate contraindications and warnings are also included in the instructions for use
 provided with the device. Interventional cardiologists are invited to participate as
 investigators in this registry. All clinicians will have experience with the treatment
 and control procedures and have been trained on the use / implantation of a Drug Eluting
 stent system.

 3. AIM OF THE REGISTRY

 The purpose of this registry is to capture clinical data of ABLUMINUS® sirolimus eluting
 stent in real world, all comer patients with Diabetes Mellitus.

 4. REGISTRY DESIGN

 Prospective, Observational, Multi-center clinical registry to be conducted in Italy at
 15 Interventional cardiology centers. 1000 patients will be enrolled and evaluated. All
 the patients will be followed up for up to 5 years.

 4.1 Treatment Strategy

 The investigator will determine the treatment strategy. It is recommended that each
 enrolling investigator review the most recent IFU to assess contraindications, warnings,
 and precautions for treating potential patients.

 5. ENDPOINT

 5.1 Primary endpoints

 Target Lesion Failure, which is composite of cardiac death, target-vessel myocardial
 infarction, and clinically indicated target lesion revascularisation within 12 months.

 Components of the primary end point are defined as follows:

 • Cardiac Death: any death due to immediate cardiac cause, deaths related to the
 procedure, unwitnessed death, and death of unknown cause.

 -  Target Vessel Myocardial infarction: categorized according to the Minnesota
 electrocardiographic criteria (Q-wave and non-Q-wave). Spontaneous myocardial
 infarction was defined as a typical rise and fall of creatinine kinase-MB fraction
 or troponin in the presence of at least one of several conditions: ischemic
 symptoms, new pathological Q waves, ischemic electrocardiographic changes, or
 pathological evidence of acute myocardial infarction. Peri-procedural myocardial
 infarction was defined as an increase in creatinine kinase to more than twice the
 normal value with increased values of confirmatory biomarkers (creatinine kinase-MB
 fraction or troponin higher than usual). Target-vessel-related myocardial
 infarction was one related to the target vessel or that could not be clearly
 related to another vessel.

 -  Clinically indicated target lesion revascularisation: any repeat percutaneous or
 surgical intervention due to a stenosis or occlusion within the device of the index
 procedure 5.2 Secondary endpoints

 -  Stent thrombosis [Time Frame: 1 month, 12 months, yearly]: Definite and probable
 stent thrombosis according to ARC definitions.

 -  Cardiac death [Time Frame: 1 month, 12 months, yearly]

 -  Target Vessel Myocardial infarction [Time Frame: 1 month, 12 months, yearly]

 -  Target Lesion Revascularisation [Time Frame: 1 month, 12 months, yearly]

 -  Device Success at 24 hours

 -  Lesion Success at 24 hours

 -  Procedural Success at 24 hours

 6. REGISTRY POPULATION

 6.1 Number of patients 1000 patients will be enrolled at 15 interventional cardiology sites
 in Italy. Duration of enrollment will be 12 months.

 6.2 Type of Patient Patients eligible for PCI (Percutaneous Coronary Intervention) with
 lesions suitable for stent implantation and having diabetes Mellitus will be included
 according to the inclusion and exclusion criteria specified below. The inclusion criteria
 will be kept comprehensive to reflect routine clinical practice of treatment (Real world
 Scenario-All comer patients).

 1. Inclusion Criteria

 1. The patient must be at least 18 years of age. 2. Diabetic patient having clinical
 evidence of myocardial ischemia (e.g., stable or unstable angina, silent ischemia or
 positive functional study; acute coronary syndromes will be considered).

 3. The patient is an acceptable candidate for percutaneous trans luminal coronary
 angioplasty (PTCA),stenting and emergent coronary artery bypass graft (CABG) surgery.

 4. Culprit de novo lesion in a native coronary artery with significant stenosis (>50% by
 visual estimate) eligible for stent implantation (no limitation on the number of treated
 lesions, vessel and lesion length); 5. Patients included are those for whom the
 physician has already considered worthwhile the use of Abluminus Stent according to the
 indications provided by the IFU; 6. Patient provides written informed consent; 7.
 Patient agrees to all required follow-up procedures and visits.

 2. Exclusion Criteria

 1. The patient has a known hypersensitivity or contraindication to any of the
 following medications: Heparin, Aspirin, Both Clopidogrel and Ticlopidine,
 Sirolimus, Paclitaxel, ABT 578 Stainless steel, Chromium; Cobalt, biodegradable
 PLLA polymer.

 2. Patients with hypersensitivity to contrast media who cannot be treated with
 adequate prophylaxis

 3. Female of childbearing potential, unless a recent pregnancy test is negative, who
 possibly plan to become pregnant any time after enrollment into this study;

 4. History of bleeding diathesis or known coagulopathy (including heparin-induced
 thrombocytopenia), or will refuse blood transfusions;

 5. Patients who are actively participating in another drug or device investigational
 study, which have not completed the primary endpoint follow-up period.

 6. Previous coronary intervention on target vessel;

 7. Non-cardiac co-morbid conditions are present with life expectancy <1 year or that
 may result in protocol non-compliance (per site investigator's medical judgment);

 8. Lesions not allowing a complete balloon inflation or stent deployment.

 7. REGISTRY PROCEDURES

 7.1 Patient Information

 Eligible patients will be informed about the registry and have to sign informed consent
 before or after the procedure (see Appendix I: informed consent form).

 7.2 Baseline Evaluation

 At inclusion into registry, the following routine examination, if performed, will be
 captured:

 1. Physical examination and relevant medical history; 2. Angina status; 3. Routine
 laboratory tests including complete blood count (CBC), blood chemistry, blood sugar and
 lipids, CK and/or CK-MB prior to the procedure. In case of acute myocardial infarction
 or infarct extension we suggest CK and/or CK-MB immediately prior to the procedure and
 serial measurements every 8 hours after the procedure until the peak CK level has been
 defined 4. 12-lead electrocardiogram before the procedure.

 7.3 Stent Implantation

 During the index procedure, only ABLUMINUS® sirolimus eluting stent system will be
 implanted. Using the instruction for use (IFU), provided with the device, the
 investigator will choose the appropriate length and diameter of the stents to be
 implanted by visual estimation.

 The choice of the length of the stent should ensure complete coverage of the lesion. If
 more than one stent is implanted, at least 2 mm overlap should be achieved. In case of
 insufficient stent expansion, the stent will be post-dilated with an appropriately sized
 balloon.

 Treatment of multiple target vessels (within the same procedure) and staged procedures
 which occur within 90 days of the initial implant procedure are allowed. ABLUMINUS®
 sirolimus eluting stent system implanted in non-target vessels after > 90 days after the
 initial implant procedure will not be followed under the ABLUMINUS® sirolimus eluting
 stent system registry protocol.

 As such, any subsequent treatment of the lesion already present at the time of baseline
 procedure will be considered as a staged procedure, instead of a repeat PCI. In the CRF
 (Case Report Form), the investigator will complete a 'staged procedure' module
 indicating that this lesion was present at the time of first procedure. The lesions
 diagnosed and treated at the later stages will not be considered as "repeat"
 revascularization.

 For each individual lesion treated, a separate lesion form in the CRF needs to be
 completed. Every vessel in which anABLUMINUS® sirolimus eluting stent system is
 implanted (or in which an attempt to implant anABLUMINUS® sirolimus eluting stent system
 is made) within 90 days of the initial implant procedure is considered a target vessel.

 For patient undergoing a staged procedure, the follow up schedule will be calculated
 from the date of initial ABLUMINUS® sirolimus eluting stent system implant procedure.

 8. ANTITHROMBOTIC TREATMENT

 Pre- procedure*: Aspirin 75mg minimum;

 Patients without any therapy: clopidogrel bisulphate: loading dose of 300-600mg per os
 before or during the procedure;

 Patient on clopidogrel therapy (within 7 days prior) no loading dose required.

 Ticagrelor or Prasugrel in the case of Acute Coronary Syndromes

 During Procedure*: At least 5000IE or 70-100IE/Kg unfractioned heparin to maintain an
 ACT > 250 seconds during the procedure.**

 Post-procedure*: DAPT Therapy for at least 6 months (IFU), or longer according to
 current Guidelines Aspirin 75mg per os life long.

 *Or according to standard clinical practice. / **The use of GP IIB/ IIIA inhibitors is
 left to the discretion of the operator.

 9. FOLLOW-UP PERIOD

 Patients will be followed after hospital discharge up to 5 years after the index
 procedure. This includes telephone contacts to obtain information regarding medical
 history, cardiovascular drug use, hospitalizations, and adverse events at 1 month, 6
 months 12 months, and then yearly post procedure. Apart from clinical follow -ups there
 is angiographic follow-up which is clinically driven (symptom driven).

 10. SERIOUS ADVERSE EVENT REPORTING

 10.1 Serious Adverse Events (SAEs)

 An adverse event (AE) is report as serious which lead to:

 -  Death

 -  Life-threatening illness or injury, or

 -  Permanent impairment of a body structure or a body function, or

 -  In-patient or prolonged hospitalization (see note below), or

 -  Medical or surgical intervention to prevent life-threatening illness or injury or
 permanent impairment to a body structure or a body function.

 Note: For the purposes of this study, in-patient hospitalization is defined as the
 subject being admitted to the hospital, with the exception of any planned
 hospitalization for a pre-existing condition or a procedure required by the local
 standard of care, which do not have to be reported as an SAE.

 All serious adverse events must be reported to the Principal Investigator within 24
 hours of discovery or notification of the event and to the local EC, as per local
 requirements.

 The Principal Investigator is responsible for reporting adequate information on SAEs
 that may be related to the study device to the regulatory authorities per country's
 applicable reporting requirements.

 10.2 Unanticipated Serious Adverse Device Effect (USADE)

 Any serious adverse effect on the health or safety or any life-threatening problem or
 death caused by, or associated with, a device, if that effect, problem, or death was not
 previously identified in nature, severity or degree of incidence in the investigational
 plan or application (including a supplementary plan or application), or any other
 unanticipated serious problem associated with a device that relates to the rights,
 safety, or welfare of subjects.

 Unanticipated Adverse Device Effects must be reported to the manufacturer as soon as
 possible following the standard vigilance route. Reporting the event ONLY in the CRF is
 not an option.

 11. MACE ADJUDICATION

 All registry devices related Major Adverse Cardiac Events (MACE) will be reviewed &
 classified by the treating physician. In case of a stent thrombosis or severe stent
 restenosis, these events will verify the stent thrombosis & determine the % Diameter
 Stenosis (DS) by QCA.

 12. STATISTICAL ANALYSIS

 12.1 Analysis Population All patients who are successfully registered will be included
 in the analysis.

 12.2 Sample Size Calculations and Assumptions Being this an observational registry
 aiming at quantifying effect estimates without direct comparisons to literature
 benchmarks, we proceeded without a formal power analysis. As the main analysis is a
 pooled analysis of all included patients, an overall and comprehensive analysis is
 planned as the primary analytical approach to reflect real-world patients and practice.

 12.3 Statistical Analyses Continuous endpoints will be summarized by presenting the
 total number of patients, mean, standard deviation, median, minimum, and maximum.
 Tabulation of categorical parameters will include counts and percentages. Survival
 analysis will be performed with the Kaplan-Meier method. Statistical inference will be
 based on the computation of 95% confidence intervals using the adjusted Wald method.
 Additional analyses will involve key subgroups defined according to baseline and
 procedural features, with statistical significance set at the 5% 2-tailed level.
 Specifically, Student t, Fisher exact, and log-rank tests will be used for such
 bivariate analyses, whereas multivariable linear regression, logistic regression, and
 Cox proportional hazard analyses will be used to adjust for confounders.

 13. QUALITY CONTROL AND ASSURANCE

 13.1 Quality Assurance The Principal Investigator of the Centre is responsible for the
 overall clinical management of patients admitted to his center, and assumes global
 responsibilities for him and his staff and the data obtained from study participants; he
 ensures compliance with the protocol, laws and regulations, ensures informed consent to
 be signed and that the CRF is accurate and complete.

 In accordance with Italian law and the ICH/GCP guidelines, the investigators and the
 institution will allow representatives of regulatory agencies and Ethics Committee
 direct access for review of the original documentation of patients, to verify compliance
 with the procedures and the veracity of the data.

 13.2 Source Data The investigator assures that medical files are appropriately stored
 and completed. Each follow up contact will be reported in the source data & should at
 least contain the information collected by the registry. The investigator assures that
 medical files and case record forms are accessible for inspection by Competent
 Authorities.

 13.3 Monitoring The study will be performed according to "good clinical practice ". The
 collection of personal, procedural and clinical data of patients must take place into
 the electronic CRF, to which will only have access the individual investigators and the
 study principal investigator (Dr Luca Testa) as "administrator ".

 13.4 Publication policy All study investigators are committed to publishing the results
 at both conferences and international journals. The P.I. of the study will have the
 right to present the main results before other investigators and will be the owner of
 the data. After obtaining the consent of the P.I., the other experimenters will publish
 and present the full or partial results of the study.

 All investigators undertake to publish the study results, whether they are positive,
 negative, or unexpected.

 14 ETHICAL CONSIDERATION

 14.1 General Guidelines This registry will be conducted in accordance with ICH- GCP
 (Good Clinical Practices). The registry will be performed in accordance with the
 Declaration of Helsinki and ISO 14155:2011 and MED DEV 2.7.1 rev. 3.

 14.2 Ethics Committee The protocol, informed consent form and other registry-related
 documents will be submitted to the Institutional or Local Ethics Committee, if
 applicable or are required for approval to initiate.

 14.3 Informed Consent A signed Informed Consent (sample attached) must be obtained
 before enrolment. Importantly, patients' participation in the study is voluntary, thus,
 they may decide to terminate their involvement at any time by withdrawing consent.

 Bibliography

 1) Stefanini GG, Holmes DR Jr. Drug-eluting coronary-artery stents. N Engl J Med
 2013;368:254-65.

 2) Serruys PW, H.E. Luijten, K.J. Beatt, et al. Incidence of restenosis after successful
 coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in
 342 consecutive patients at 1, 2, 3, and 4 months, Circulation 1988;77(2):361-371.

 3) Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused
 update of the guideline for the diagnosis and management of patients with stable
 ischemic heart disease: a report of the American College of Cardiology/American Heart
 Association Task Force on Practice Guidelines, and the American Association for Thoracic
 Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular
 Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014;
 64:1929-49.

 4) Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial
 revascularization: The Task Force on Myocardial Revascularization of the European
 Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery
 (EACTS) developed with the special contribution of the European Association of
 Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619.
Inclusion Criteria:

 -  The patient must be at least 18 years of age.

 -  Diabetic patient having clinical evidence of myocardial ischemia (e.g., stable or
 unstable angina, silent ischemia or positive functional study; acute coronary
 syndromes will be considered).

 -  The patient is an acceptable candidate for percutaneous trans-luminal coronary
 angioplasty (PTCA) stenting and emergent coronary artery bypass graft (CABG) surgery.

 -  Culprit de novo lesion in a native coronary artery with significant stenosis (>50% by
 visual estimate) eligible for stent implantation (no limitation on the number of
 treated lesions, vessel and lesion length);

 -  Patients included are those for whom the physician has already considered worthwhile
 the use of Abluminus Stent according to the indications provided by the IFU;

 -  Patient provides written informed consent;

 -  Patient agrees to all required follow-up procedures and visits.

 Exclusion Criteria:

 -  The patient has a known hypersensitivity or contraindication to any of the following
 medications:Heparin, Aspirin, Both Clopidogrel and TIclopidine, Sirolimus, paclitaxel,
 ABT 578Stainless steel, Cobalt, biodegradable PLLA polymer.

 -  Patients with hypersensitivity to contrast media who cannot be treated with adequate
 prophylaxis.

 -  Female of childbearing potential, unless a recent pregnancy test is negative, who
 possibly plan to become pregnant any time after enrolment into this study.

 -  Patients who are actively participating in another drug or device investigational
 study, which have not completed the primary endpoint follow-up period.

 -  History of bleeding diathesis or known coagulopathy (including heparin-induced
 thrombocytopenia), or will refuse blood transfusions

 -  Previous coronary intervention on target vessel.

 -  Non-cardiac co-morbid conditions with life expectancy <1 year or that may result in
 protocol non-compliance (per site investigator's medical judgment).

 -  Lesions not allowing a complete balloon inflation or stent deployment.