ABIOMED Inc (ABMD) 2012 Q3 法說會逐字稿

Good day, ladies and gentlemen and welcome to the third quarter 2012 Abiomed, Incorporated earnings call. My name is Kevin, and I will be your operator for today. Later we will conduct a question-and-answer session.

(Operator Instructions) I would now like to turn the call over to your host for today, Ms Aimee Maillett, Mr. Micheal Minogue and Mr. Robert Bowen. Please proceed.

Thanks you. Good morning and welcome to Abiomed's third quarter of fiscal 2012 earnings conference call. This is Aimee Maillett of Abiomed Corporate Communications Department. I'm here with Mike Minogue, Abiomed's Chairman, President and Chief Executive Officer and Bob Bowen, Vice President and Chief Financial Officer. The format for today's call will be as follows -- first, Mike will provide you with strategic highlights for the third quarter. Next, Bob will provide details on the financial results outlined in today's press release, and we will then open up the call for your questions.

Before we begin discussing the third quarter, it is necessary to remind you that, during the course of this call, we will be making forward-looking statements including statements regarding future financial performance, product development efforts, Abiomed's strategic operational initiatives, market response to our new products, our progress towards commercial growth and future opportunities. Abiomed's actual results may differ materially from those anticipated in these forward-looking statements based upon a number of number factors, including -- uncertainties associated with development, testing and related regulatory approval; competition; technological changes; anticipated future losses; complex manufacturing; high-quality requirements; dependence on limited sources of supply; government regulation; future capital needs and other risks detailed in our SEC filings. Investors are cautioned not to place undue reliance on any forward-looking statements which speak only as of the date of today's conference call. The company undertakes no obligation to publicly release the results of any revision to these forward-looking statements that may be made to reflect events or circumstances that occur after the date of this conference call or to reflect the occurrence of unanticipated events. We will be referring to some non-GAAP financial items on this call. I would encourage everyone to refer to today's earnings release for a full reconciliation of non-GAAP items to the GAAP equivalents. Lastly, unless otherwise indicated, comparative references on this call to increases or decreases in revenue, expenses, gross margin or other financial measures relate to the third quarter of fiscal 2012 as compared to the third quarter of fiscal 2011.

I am now pleased to introduce Mike Minogue, Abiomed Chairman, President and Chief Executive Officer.

Thanks, Aimee. Good morning, everyone. We are again proud to report the best quarter in Company history with 18% growth in total revenue at $32.2 million and 31% growth in Impella revenue. We continue to grow sequentially and year-over-year in both revenue and patients supported. Best ever Company results are also reported this quarter on Impella revenue, Impella reorder revenue, total patients supported, GAAP and non-GAAP net income and cash generation. We are achieving these best ever financial results in a challenging economic and regulatory environment and simultaneously advancing our strategic goals in R&D, clinical studies, on our product portfolio, our regulatory path in Japan, while expanding our US commercial organization. This quarter exemplifies our Company philosophy of adapt and execute. I personally want to thank and congratulate the entire team for our best quarterly performance.

Today I would like to highlight the quarter relative to our four corporate goals. So first, on goal number one -- advancing Impella utilization by focusing on patient outcomes for procedures requiring prophylactic and emergency hemodynamic support. The breakdown of reported usage was 51% for prophylactic PCI, 30% for emergency shock, 6% for EP and 14% for all other applications. Both prophylactic and emergency usage grew double-digits, sequentially and year-over-year, with record new highs on patients supported. To note, this Q3 quarter included the TCT meeting and followed the double-digit sequential growth in Q2.

The most significant catalyst announced this quarter for utilization was Impella being included in the ACC/AHA/SCAI -- which is S-C-A-I -- guidelines for high risk PCI and AMI cardiogenic shock. The guidelines highlighted the importance of incorporating more appropriate hemodynamic support and referenced several Impella studies while including the intra-aortic balloon pump meta-analysis publication reporting no benefit for IABP usage. Additionally there were 13 peer reviewed manuscripts published on Impella in Q3 and with 22 presentations at TCT.

At TCT, insightful new core lab data from PROTECT II was presented on the appropriateness and quality of the PCI, concluding that extensive revascularization provided the best outcomes in this high-risk patient population. We have completed a thorough review of PROTECT II with the steering committee, and the first of several papers will be submitted in early February. The publication road map has been established for several other papers, including the cost effectiveness study, pre-specified subgroup analysis, the core lab analysis of the completeness of revascularization and other post hoc analyses. We expect a tidal wave of peer-reviewed papers over the next two years on this landmark study.

Our second goal is quantifying the cost benefits and quality of life gains with hard muscle recovery for patients requiring prophylactic and emergency hemodynamic support. Abiomed has amassed a compelling body of clinical and economic evidence. In PROTECT II, the economic study revealed that the Impella patients had lower hospital charges at 90 days, driven by 47% reduction in repeat revascularization and 67% lower charges per readmission as compared to the intra-aortic balloon pump. Our heart recovery mission resonates with the payers and the providers because of the focus on 90-day outcomes with patient quality of life metrics tracked in detail. The days of staging PCI and bringing patients back multiple times within 90 days for another elective cath procedure are over. In PII, there was a 57% reduction in major adverse event rates in the Impella arm post-hospital discharge to 90 days. Even before the recent updated guidelines, Impella had already been issued coverage by the Center for Medicare and Medicaid; endorsed by the Interventional Cardiological Physicians Society, called SCAI; and independent third party consultants like the Advisory Board, as well as top published physician experts.

From a quality of life perspective, PROTECT I, PROTECT II, MACH II and the USpella registry recently published have all reported a significant increase in ejection fraction and improved New York Heart Association status for Impella-supported PCI patients. This PCI treatment option represents a new, minimally invasive alternative for many of these high-risk, chronic heart failure patients not being treated today in the cath lab. To note, 64% of PROTECT II patients were formerly declined surgically.

Now, relative to emergency acute heart failure patients, we are confident, based on the data, that recovering heart muscle provides the maximum quality of life for the patient and ranks as one of the most cost effective treatments in the industry. YouTube now includes 37 inspirational local hospital news stories on our patients returning home with their native heart. These stories reiterate the fact that heart recovery from acute events eliminates more invasive and expensive treatments. And this is what we all want for our family and friends.

The Symphony concept is also the epitome of a cost effective solution for worn out hearts, because it is the first minimally invasive implantable pump designed to assist the heart and kidneys while potentially enabling remodeling of the left ventricle. These pre-VAD Class III patients represent a new paradigm to treat heart failure with a break through technology at a cost effective price. To remind everyone, the Symphony is not yet FDA approved or for commercial sale within the United States.

Our third goal is maximizing the productivity of our commercial organization. We achieved significant revenue growth despite the hospital end of year practice to minimize inventory levels. Our go deeper strategy has been working, however, this quarter included 12 more new site openings than anticipated based on a very strong demand tied to end of year hospital budgets and the guideline TCT announcements. In fact, some of the new sites purchased the new automated Impella console or AIC, and we also shipped a record number of AIC consoles with service contracts to our installed base users. In this Q4 we will have to compensate for all the time and training associated with new site openings and AIC upgrades, as well as the ACC meeting, and we still expect sequential growth in utilization. Our service business grew 21% this quarter as we service our consoles in over 600 US hospitals with a mix of multi-year service agreements and hourly billed service. We plan to continue to invest in our commercial organization and have approximately 90 people in the field. We plan to continue adding four US field employees per quarter moving forward.

Our fourth and final goal is driving operational excellence and customer service. We are executing on our tactical plans across all the departments. The introduction of the new AIC console has received rave reviews from our users. The Impella RP or right side percutaneous pump, has truly saved lives outside of the US, and the first Impella Bi-VAD patient has been successfully reported to recovery and is being submitted for publication. We initiated the FDA pilot study called MINI and enrolled the first patient. This study focuses on addressing a new population of several hundred thousand patients with stable hemodynamics and AMI, already proven to be unresponsive to the intra-aortic balloon pump. The planned summer introduction of the Impella cVAD has garnered attention from customers lining up to be the pilot sites. In Japan we continue to make progress and maintain a calendar year 2013 approval time line. The Symphony product announced at AHA had the first-in-man experience reported at our investor day and late-breaking clinical trials at the annual meeting for the Society of Thoracic Surgeons this month. And as we have highlighted in our investor day, we estimate a potential future US market of over 100,000 patients for the Impella RP and Symphony combined.

So, in summary, the Company's drive and execution were evidenced this quarter by the release of new clinical and economic data, new products and best ever financial performance. We have arrived to stay in the cath lab and established our platform for the future based on our financial stability and core competency of recovering hearts and saving lives while leading in innovation. As always, Abiomed is highly motivated to help thousands of patients and create significant shareholder value. With Impella now at an annual run rate of over 100 million and growing greater than 30%, we believe Abiomed is just in the early innings of our potential market and look forward to the future.

I would now like to turn the call over to Bob Bowen, our CFO.

Thank you, Mike. And good morning, everyone. Before I get started, I would like to refer you to the Safe Harbor language noted at the outset of the call as well as the risks and uncertainties noted in our SEC filings, particularly our most recently filed 10-K. I would also like to bring to your attention the GAAP, non-GAAP reconciliation that we have provided in the earnings press release, which is intended to aid investor understanding of our financial results. Overall revenue was up 18% from last year to $32.2 million and included strong growth in both the US, up 17% to $29.6 million, and outside the US, up 37% to $2.6 million. Service revenue increased 21% to $1.7 million and all other revenue from the sales of BVS 5000, AB5000 and funded research and development was $2.8 million, 39% lower than the prior year. Worldwide Impella revenue totaled $27.7 million, up 31% from the prior year. As we discussed on a prior call, the Impella 2.5 catheter inventory levels at hospital sites were lower than we had thought and was the rationale for no longer reporting exact patient numbers since independent usage was likely increasing.

Today, I would like to provide a brief update on the Impella 2.5 inventory levels at hospital sites. We have completed implementation of a comprehensive tool set that allows us to monitor specific inventory levels for each product type at each site by serial number based on reported patient use and shipment data. What we have found is that hospitals are tightly managing inventory levels and that Impella 2.5 site inventory levels have slightly decreased since the start of the fiscal year. On a per site basis, most of that decrease occurred in fiscal Q3 as hospitals closed out their calendar years. Put another way, in fiscal Q1 and fiscal Q2, the number of Impella 2.5 patients reported was very close to the number of Impella 2.5 reorders. Whereas in fiscal Q3, the number of Impella 2.5 patients reported was 6% higher than the number of Impella 2.5 reorders, resulting in a decrease in field inventory levels. This could be the result of year-end hospital inventory management or simply timing of receiving reorders compared to timing of use, particularly during the year-end holidays. Additionally, many of our customers expect same day or overnight delivery for emergency patients. The average number of Impella 2.5 catheter units is 2.2 units per site, with a median of 2 units, both of which are below our recommended par level of 3 units and below the initial stocking order of 3 units. Approximately 6% of our sites carry 4 to 5 units in inventory, and those tend to be our highest users.

Gross margin for the quarter at 80.5% was, again, above our guided range of 78% to 80% and compared to 80% in the year-ago period. Despite placing 139 Impella consoles in Q3 fiscal year '12, compared to 78 in the prior year, margin rates improved due to a higher portion of revenues from Impella disposables, higher unit production volumes, which leveraged the fixed portion of our manufacturing costs, and favorable yields. Since the start of this fiscal year, approximately 25% of total Impella 2.5 sites have received and are now benefiting from the ease of use of the new automated Impella controller, reflecting the continued strong customer demand to incorporate the latest Impella technology and platform.

R&D expenses of $6.1 million compared to $6.6 million in the prior year. Clinical trial expenses of $0.9 million in the most recent quarter compared to $2.1 million in the prior year, and the decrease was due to the winding down of the PROTECT II trial. The remaining R&D expenses associated with sustaining engineering and new product development totaled $5.2 million compared to $4.5 million in the prior year. The increase was largely due to new product development initiatives associated with the Impella cVAD, Symphony and Impella RP. As a reminder, most costs associated with development and market entry of these products are recorded as R&D expenses until regulatory approval is received, at which time we will begin to capitalize material costs into inventory.

Selling, general and administrative costs were $17.2 million, up 10% compared to $15.6 million in the prior year as a result of the continued build out of our US commercial organization, along with marketing related initiatives. Total operating expenses for fiscal Q3 were $23.7 million, compared to $22.5 million in the prior year or up 5% on an 18% revenue increase, which reflects the strength of the P&L leverage. Similar to last year, we expect our fourth quarter operating expenses to be up sequentially approximately $1.5 million from the third quarter, due to continued build out of the commercial organization, customer trading initiatives and product development expenditures. We have now had two quarters in a row with positive income from operations. In Q3, income from operations totaled $2.2 million or 6.8% of revenue and in fiscal Q2, income from operations of $0.6 million was 2% of revenue. The team has really delivered to get to this point and we are clearly executing in the near term and investing for the future as well.

GAAP net income for fiscal Q3 was $2.9 million or $0.07 per diluted share and included a nonrecurring favorable settlement of $1 million. This compared to GAAP net loss of $0.8 million or a loss of $0.02 per basic and diluted share in the prior year. We have achieved GAAP profitability, and our current plans continue to call for a profitable fiscal Q4 as noted on our last earnings call. The non-GAAP net income, as described in our press release, was $4.6 million in fiscal Q3 compared to a non-GAAP income of $1.4 million in the prior year.

Looking at the balance sheet, accounts receivable of $17.3 million had days sales outstanding of 49 days, up from 43 days in the prior year, but still within a very positive range. And inventory of $9.7 million turned at 2.8 turns compared to 2.6 turns in the prior year. We ended the quarter with cash, cash equivalents and short-term marketable securities of $69.6 million, up $8.8 million from $60.8 million at the start of the quarter and up $9.3 million from the start of the year. Notably, cash flow from operations, less capital expenditures, was $4.1 million in fiscal Q3 with a balance coming from stock option exercises and a nonrecurring $1 million settlement.

This is the second quarter in a row of positive operating cash flow. In the prior sequential quarter, cash flow from operations, less CapEx, was $1.6 million. This is an enormous achievement that reflects the disciplined and attention to detail management style that permeates Abiomed. Based on our current plans, we would expect to see an increase in cash, cash equivalents and short-term marketable securities in Q4 as well. As a reminder, we have no debt and, as of the start of the year, we had a federal net operating loss carry forward of approximately $183 million and a federal research and development credit carry forward of approximately $9.3 million.

Turning to guidance -- full year revenue guidance for fiscal '12, as noted in our press release, is updated from the previous range of $120 million to $125 million to the range of $122 million to $125 million, representing an annual growth rate in excess of 20%. Year to date, Impella revenue is up 34%, at the high end of the Impella range we have guided to since the outset of the year of 30% to 35%. We expect to see continued strong Impella growth driven by increased utilization, with fewer new Impella 2.5 site openings in fiscal Q4 and continued softness in the legacy product revenue. We will now open the call to questions. Operator, would you please open up the line?

(Operator Instructions)

Greg Simpson, Wunderlich Securities.

Thanks. Good morning, guys, and congratulations on a great quarter. Let me start -- I've got, I guess, three primary questions and I'll get back in line. First of all, obviously, you have to be impressed by the operating leverage we saw this quarter. Can -- Bob, you gave us a little information on spending levels going forward and, obviously, you guys have been able to do an awful lot on the R&D side, really over the past several quarters and get a lot of productivity, I guess, out of that -- out of that line. You gave us a little guidance on the spending levels. Can you maybe talk about spending levels going forward, or maybe the better way to put it is what kind of drop down are you comfortable with to the operating line as -- now that we're past kind of that magic $30 million revenue mark on a quarterly basis? What kind of operating -- or what kind of drop down to the operating line should we probably expect going forward?

Yes. So, Greg, you know, we are -- we're currently in the planning stage for our fiscal year '13, and so my preference would be to, you know, not get too specific until our next call where we would expect to give more color on that. But, obviously we've demonstrated that we can drop down a good piece of our revenue to the bottom line. We also recognize we've got three very new, exciting products coming in our future, and we plan to continue invest in them, as well as in our commercial organization. Both, frankly in the US, and we're also seeing signs of good growth in Europe, and so we're probably going to invest a little bit more there, and we've got Japan coming. So, I mentioned that sequentially we're going to be up about $1.5 million in operating expenses in Q3 versus Q4, and I think for now that's probably not a bad place holder to think about on a go-forward basis.

Okay. And by that, you mean -- you talk about a quarterly increase of that magnitude going forward or that kind of spend level?

Quarterly increase.

Okay. Secondly, Mike, you referenced the new centers, that was one of my questions. So, obviously, you had a big surge in demand from new centers coming out of TCT. What I've seen historically in this industry, and I think we probably saw it with you guys with the PROTECT II presentation at ACC, when you have positive news like that with this kind of customer base, there seems to be kind of a lag effect. So I'm curious, with respect to the impact on utilization, is it logical to assume that the impact of all the good stuff from TCT probably wouldn't be seen for a quarter or two?

Well, Greg, I think it's a good question and a realistic point that you're making in that what we've been talking about is what drives utilization is training and data. And so the training is making the product easier to use and to have more hands-on support at sites, transitioning them from prophylactic use to emergency. The second component that really drives usage is data. And we've had USpella published, we've had presentations at TCT, and now, being in the guidelines is probably the most significant amount of data or support we've had for this technology. And the third element of it is time. So, we had a very strong quarter, we're growing sequentially in year over year and we think that, again, we're just getting started because there -- you know, we're probably at 5% of the balloon pump usage. And I think our story is even stronger than it's ever been. So, I think it's going to continue, and I think you're going to see strong growth going forward on Impella.

Okay. I was actually trying to get you to commit to basically indicating that we'd see the impact of TCT actually in forward quarters. We didn't really see it yet in this quarter other than the new site openings.

(multiple speakers) I'm aware that you're trying to get me to say that.

Fair enough.

We had a very good quarter. Impella is already growing greater than 30%, and we're proud of that, and I think that we have a very good story moving forward.

I can no longer trick you. Final question. Obviously, you've consistently had a very healthy balance sheet; but, again, with this kind of operating leverage, and the cash is really starting to grow. So, without trying to get you bombarded by investment banker phone calls, what are kind of the plans? I mean, you're sitting on $70 million in cash and no debt, and the operating leverage is impressive. I mean, are there any plans going forward to deploy that cash at some point?

The current plans are to execute on our existing strategic goals, and we like the position we're in with hoarding our cash and having no debt.

Okay. Good enough. Again, congratulations on the quarter.

Thanks, Greg.

Brooks West, Piper Jaffray.

Good morning, guys, it's Dan Garofalo on for Brooks this morning. Congrats on the quarter. There's a lot of concern coming in just related to how much the sales force was out of the field, but yet you put up great numbers. I'm wondering if you can give us a sense of how that might have affected things and where things maybe could have been had that not been the case.

We grew sequentially double digit year over year, so that's a stellar performance knowing that TCT, the largest shows -- and not only our field people were out, but some of our best customers were preparing for TCT and then out for a week. What I think is starting to make up for that is we have a broader group of applications, and we have growing independent usage. One out of every three Impellas is put in independently, and we suspect it's probably higher than that because we're not able to track all the independent usage anymore. And that's the business model is we're going from -- you know, back to the mantra of training and data is you're seeing applications, you're seeing publications. So we're becoming, I guess, less reliant on a handful of customers that might have attended TCT, and we're also driving a broader base of users and independent use.

Okay. Great. And just one related follow-up, if I could. Just wondering if you can talk a little more about your sense for the reaction in the field based on the data and guidelines in the past quarter. You added the 37 new hospitals, but can you give us a sense from both a penetration standpoint as well as reach what you're seeing and hearing out there?

Yes, I mean, you know, from what we're hearing and seeing, it's all very positive. The proof of that is the utilization is up, and I think the -- not just the guidelines, not just the USpella publication, not just the PII data, but also the cost effectiveness and the quality of life of what heart recovery means. And I'd encourage everyone to go on to YouTube and type in Abiomed or Impella and see the impact it's making in patients. I think sometimes people forget the importance and the amount of exposure that gives technology because patients are becoming very educated. The surveys all show they want to keep their own heart, they want to avoid a major surgery, and what heart recovery represents is really where the global healthcare reform is going. So it's all positive and we're just going to continue to publish and execute.

Great. Thanks for taking the questions.

Anthony Petrone, Jefferies.

Thanks, gentlemen. Mike, first I will begin a little bit more on the Impella performance in the quarter. And if you could just tell -- you did give the number of patients that were previously untreatable, and that was 64% in the quarter. Can you give a sense of -- is the growth really that we have an increasing pie now out there of untreatable patients that are now treatable, or do the guidelines really push it this quarter? And, of course, you have the cost savings data that you presented at TCT as well. So, among all of these drivers what would you say is really, you know, kind of the push from this quarter in the field?

So, Anthony, just to clarify, the 64% that were turned down from surgery is the statistic from the PROTECT II high-risk PCI study, the FDA study. So, what that says is that we're comparing Impella to the balloon pump and that spend is 26,000 intra aortic balloon pumps that were reported in use for high-risk PCI, but what also is shown is that many of these patients are turned down for surgery and, in PROTECT II, had they had the ability to already treat them with the balloon pump in the cath lab, they likely never would have made it to surgery to be turned down. So, there certainly is an element of patients now that are either turned down for surgery or turn down surgery. We estimate that it's greater than another 10,000 patients because there are a lot of Class III, Class IV patients with ischemic heart failure who are in and out of the hospital, and that can be a significant number as we outlined in our investor day. So, I think that everything happening in the quarter, you know, it happened in November, so the effects of the guidelines, the effects of TCT are really not yet baked in because we were midway through the quarter on those numbers. So, it gives us a reason to be very excited.

The second thing is what's in the guidelines really specifically talks about, for the first time ever, Impella, and it mentions that revascularization may necessitate more intensive cardiac support with a ventricle-assist device or other hemodynamic support to allow for myocardial recovery. This is the first time this has been into the guidelines. And then, even on high-risk PCI it talks about hemodynamic support for carefully selected high-risk patient populations. So, we think that's very insightful, it's very supportive; and, if you look at what happened with the SYNTAX study, which was PCI versus CABG, the recent guidelines also changed unprotected left main from inappropriate to uncertain and that's based on the SYNTAX post hoc analysis study where they created the tiers. And, to remind everyone, SYNTAX and STS were measured in PROTECT II, but SYNTAX doesn't measure CABG and STS gives a score, but if the patients are turned down for surgery, it really is irrelevant. So, what's happening now is there's a new patient population, or there's a sick patient population that has a new option and that's what's most exciting about the high-risk PCI population.

That's very helpful. Just a quick follow up. You mentioned in the release the higher flow Impella. I'm just wondering the need for additional clinical data there -- any approval process timing on that? And then a couple of follow-ups for Bob.

Sure. So, Anthony, we expect it to be a 510(k) supplement and we expect to have it in commercial utilization this summer.

Great. Thanks. And, Bob, you mentioned the turn rates, and I understand that levels are down, but you also didn't mention that there was some degree of overnight purchases. So, if you have some accounts that actually have lower inventory levels with overnight purchases, in that case the inventory turns would actually be up. So, is there any way to actually track inventory turn rates at these hospitals now?

Well, we do -- we do look at beginning shipments, usage, ending, so we do look at what -- the goes in and the goes out. We haven't gotten to the point where we're actually doing inventory turns. The inventory turns I was referring to were the Abiomed-owned inventory, so essentially our manufacturing inventory. The inventory turns in the field we don't own. Those are owned by the hospitals.

Right. Right. I was just -- you're tracking it down to the serial number on the catheters, so I was wondering if you were able to get to the point where you can track turns because it just seems if you had overnight purchases with lower inventories overall, at some accounts at least, it would indicate that catheters are actually turning at a higher rate, I'm imagining, so --

Yes.

And then just lastly, on Japan, and I'll get back in queue, I'm imagining the level of spend there is going to increase. Bob, you did mention a $1.5 million sequential increase. How much can we expect in preparation for Japan? And if you would care to just, again, provide an update on the annual market opportunity there. Thanks a lot.

Yes, I think the Japan preparation costs for us are largely going to start hitting toward the end of our fiscal -- next fiscal year as we begin the market entry-related initiatives. And we'll provide more color around that on our next conference call. On the market size, there are about 25,000 balloons, I believe, used PCI procedures in Japan. So, it's a very large market opportunity for us.

Thanks.

David Lewis, Morgan Stanley.

Good afternoon, guys, this is Bill on for David. I want to look back at the center adds a little bit farther here and trying to understand whether kind of the new rate of center adds -- as you said, being based on higher amounts of demand with guideline inclusion -- is really the run rate we should look at going forward here throughout the rest of the year and into '13, or if you would expect that number to actually come back down towards the 25 centers per quarter range as we've seen over the last about year and a half here.

So, Bill, hospitals have a budgeting process where they have money left over they've budgeted for the end of the year. So we wanted to satisfy and support those that went through that procedure, but we plan to go back to the 25 range moving forward.

Okay. Great. And then, I believe our last call you had broken out kind of the mix of your Impella sales between high-risk PCI and AMI. Is that something that you guys are willing to give going forward here, or is that also along with procedure numbers something you guys are going to hold a little bit closer to the chest?

Yes, I stated it in my script. So, 51% prophylactic PCI, 30% emergency SOC, 6% EP and 14% all other.

All right. Thank you very much.

Greg Simpson, Wunderlich Securities

Yes, thanks, guys. Kind of a follow-up on the impact of the guidelines and the cost benefit data. Mike, more anecdotal in nature, but with the publication of the cost benefit data and the inclusion in the guidelines, are you -- I guess for lack of a better term -- are you winning over the doubters or the people that have maybe not been attracted to the Impella technology yet? I mean, obviously there's certainly a few that you'll never get, but can you maybe talk about that anecdotally?

Yes. So, if you're talking about our customer base of physicians, I think those that are objective that the data speaks for itself. And it's pretty hard to look at a Kaplan-Meier curve and have an agenda. It's pretty hard to look at discharging a patient, and they have a 56% reduction in adverse event rates in the Impella arm over the balloon pump arm and then looking at heart recovery in general and have an agenda. So, these physicians care about their patients. I think what's great about the YouTube videos is these are people that are treating their neighbors and their local community. They see the benefit. We hear these great stories. We talk to these patients and bring them back to talk to our people, and I think that's really what, in the end, is what's most important is clinical outcomes. And if they are those that are skeptical for those that haven't seen the TCT MD video, these are four of the most published and leading experts in interventional cardiology. And it's their thoughts and their arguments on things that explain that -- the benefits of improving outcomes, whether it's prophylactically or emergently.

Then on kind of a related note, in your go-deeper strategy at existing centers, the way I still model this, you know, I have, you know, 2 point something doctors per average center. Is this -- again, the guidelines and the cost benefit data, is that key in kind of broadening that? And again, I think of Dr. LaSalle in Washington University here in St. Louis where, you know, there's 40 interventional cardiologists that could, in theory, use the technology. You don't get them all, but at what point do we go from maybe that 2% or to 5% or 6% or 10%?

Yes, I think our strategy is not to be with every doctor, it's to be with a subspecialty of doctors who, one, want to grow a high-risk PCI practice and, two, are on call so that they're seeing these emergency patients. And there's a lot of those. We've profiled them and that's where we're just trying to move forward from interventional cardiology. With regard to the EP group, you know, many times it's the same cath lab, same scheduler. We're also working with that group and have folks that are now publishing and using it. And so that's also another way to expand our user base. And then, last, is we are seeing progress with heart surgeons that are also starting to utilize the Impella, whether it's the 2.5 or the 5.0.

Final question, you mentioned EP, I wasn't going to ask this, but EP -- is that the indication for Impella that maybe kind of came out of nowhere and is surprising you with the interest and the demand there?

You know, that's the one that really grew on its own. And, we were focused on interventional cardiology, but these are physicians that understand hemodynamics and are treating a risky patient -- in fact, they're putting the patient at risk. And, it's a nice way to really do a proof statement of how it works because you're essentially scheduling a heart attack for a patient, and you can have the Impella on and off and you can see the difference in the hemodynamics when you ablate. There's one case study where it shows, after 4 seconds of an ablation, the hemodynamics going to an unsustainable level; and then, with the Impella on, after 40 seconds, they're still in the ablation. So, it's really a great application to demonstrate the hemodynamic power of Impella.

Okay. Thanks very much.

I'm not showing any further questions at this time. I'd like to turn the call back over to Mr. Michael Minogue for closing comments.

Thank you, everyone, for your time today. And if there's more clarification you need, please call in. And have a good day.

Ladies and gentlemen, this does conclude today's presentation. You may now disconnect and have a wonderful day.