IK-5001 for the Prevention of Remodeling of the Ventricle and Congestive Heart Failure After Acute Myocardial Infarction

Heart failure is a significant problem, and carries substantial mortality. According to
studies, left ventricular (LV) remodeling contributes independently to heart failure
progression. Prevention and reversal of LV remodeling are correlated with decreased risk of
death and heart failure events. IK-5001 is an implantable device to be used in subjects with
recent myocardial infarction (MI). The IK-5001 device has been shown to directly halt the
remodeling process that occurs following acute MI. IK-5001 replaces the damaged extracellular
matrix (ECM) that has degraded during infarction, supports the damaged myocardial tissue,
prevents local dyskinesis, and decreases wall stress. Because of its minimal interaction with
the myocardium, its mechanism of action, its lack of specific pharmacologic activity and its
elimination behavior, IK-5001 is a medical device in concurrence with the Global
Harmonization Task Force's harmonized definition for medical devices.

Inclusion criteria:

Subjects must meet all of the following inclusion criteria to participate in this trial:

1. The subject is ≥ 18 years of age.

2. The subject has given informed consent.

3. The subject has experienced a large STEMI defined by the following criteria:

Peak cardiac enzyme value within 48 hours of symptom onset as follows:

- Creatine kinase MB fraction (CK-MB) > 30 x the upper limit of normal OR

- Troponin I > 200 x upper limit of normal OR

- Troponin T > 60 x the upper limit of normal

AND at least 1 of the following 3 criteria:

- Delayed presentation with PCI > 6 hours from onset of symptoms

- Significant new Q waves in ≥ 2 anterior leads or anterior ST segment elevation of
at least 3 mm persistent at 24 hours after PCI

- New onset of CHF (Killip class 3-4) or cardiogenic shock persistent at 24 hours
after PCI

AND at least 1 of the following 2 criteria:

- MI ≥ 20% by Single Photon Emission Computed Tomography scan (SPECT) or cardiac
Magnetic Resonance Imaging (MRI) with defect in the appropriate distribution

- Ejection fraction ≤ 35% with wall motion abnormality in the appropriate
distribution at baseline imaging assessment

4. The subject has had successful PCI with stent within 48 hours of symptom onset, and
residual stenosis less than 20% in the infarct related artery and greater than or
equal to thrombolysis in myocardial infarction (TIMI) 2 flow. Subjects undergoing
rescue PCI after thrombolysis or delayed presentation with ongoing ischemia may be
enrolled.

5. For Germany only: Patients determined to have Killip class 4 at time of device
deployment are not eligible for randomization.

6. For Germany only: If SPECT is used for determination of MI size in order to meet
inclusion criteria, the SPECT must have been previously performed as part of standard
clinical care. SPECT is not to be performed solely to qualify a patient for this study
in Germany.

Exclusion criteria:

Subjects will be excluded from participating in this trial if ANY of the following
exclusion criteria are met:

1. Any subject with cardiogenic shock requiring mechanical ventilation or mechanical
support at the time of deployment. Subject must be off mechanical support prior to
deployment.

2. Need for urgent coronary artery bypass graft (CABG)

3. Clinically significant valvular heart disease with planned surgical correction or
transcatheter aortic valve implantation (TAVI)

4. Uncontrolled ventricular arrhythmias

5. Renal insufficiency with a calculated creatinine clearance of less than 30 mL/ minute.
See Appendix A for determining estimated creatinine clearance.

6. Clinically significant hepatic insufficiency

7. Inadequate imaging windows (defined as the inability to visualize the endocardial
border of at least 16 of the 17 segments in both the apical four chambers and apical
two chamber views without foreshortening) or arrhythmia that would preclude adequate
3D imaging on transthoracic echocardiography at the local baseline echo assessment

8. Non-ambulatory prior to the index MI

9. The subject has participated in another trial of an investigational agent within 30
days prior to randomization.

10. Subject has received resorbable stent as part of PCI.

11. The subject is pregnant or breastfeeding. Women of child-bearing potential will have a
negative urine pregnancy test prior to randomization.

12. Any other concurrent condition that, in the opinion of the investigator, would prevent
completion of the clinical trial, including inability to comply with follow up
requirements.

13. For Germany only: In the investigator's opinion, the patient is not expected to
survive ≥12 months.

14. For Germany only: 24 hours prior to device deployment, the patient has a serum calcium
level greater than the upper limit of normal as determined by the local laboratory.