The pivotal clinical trials were for the most part restricted to low-risk patient and lesion subsets that are not completely representative of those seen in routine clinical practice. Specifically, the “on-label” indications for use of drug-eluting stents include only symptomatic patients with ischemic disease due to a single de novo lesion less than 30 mm in native coronary arteries, with a reference vessel diameter of 2.5 to 3.5 mm. Because the use of bare-metal stents in more complex lesion and patient subgroups is typically associated with higher rates of restenosis, many interventionalists have hypothesized that the efficacy of drug-eluting stents may be more pronounced in this population, with greater absolute reductions in repeated revascularization. Initial data from some of the pivotal randomized studies that included more complex lesion subsets have demonstrated this benefit (8). Additional studies are emerging about the use of drug-eluting stents for various “off-label” indications, including acute myocardial infarction (MI), chronic total occlusion, in-stent restenosis, diffuse disease, saphenous vein grafts, bifurcation lesions, and left main coronary artery stenting. In addition, several ongoing registries have provided “real-world” data that show favorable long-term outcomes and statistically significant reductions in major adverse cardiac events (11).