***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis . However , it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospect ively adjudicated end points endorsed by the Food and Drug Administration . METHODS In this multicenter , noninferiority trial with minimal exclusion criteria , we r and omly assigned 2292 patients to undergo treatment with coronary stents releasing either zotarolimus or everolimus . Twenty percent of patients were r and omly selected for repeat angiography at 13 months . The primary end point was target-lesion failure , defined as a composite of death from cardiac causes , any myocardial infa rct ion ( not clearly attributable to a nontarget vessel ) , or clinical ly indicated target-lesion revascularization within 12 months . The secondary angiographic end point was the extent of in-stent stenosis at 13 months . RESULTS At least one off-label criterion for stent placement was present in 66 % of patients . The zotarolimus-eluting stent was noninferior to the everolimus-eluting stent with respect to the primary end point , which occurred in 8.2 % and 8.3 % of patients , respectively ( P<0.001 for noninferiority ) . There were no significant between-group differences in the rate of death from cardiac causes , any myocardial infa rct ion , or revascularization . The rate of stent thrombosis was 2.3 % in the zotarolimus-stent group and 1.5 % in the everolimus-stent group ( P=0.17 ) . The zotarolimus-eluting stent was also noninferior regarding the degree ( + /-SD ) of in-stent stenosis ( 21.65+/-14.42 % for zotarolimus vs. 19.76+/-14.64 % for everolimus , P=0.04 for noninferiority ) . In-stent late lumen loss was 0.27+/-0.43 mm in the zotarolimus-stent group versus 0.19+/-0.40 mm in the everolimus-stent group ( P=0.08 ) . There were no significant between-group differences in the rate of adverse events . CONCLUSIONS At 13 months , the new-generation zotarolimus-eluting stent was found to be noninferior to the everolimus-eluting stent in a population of patients who had minimal exclusion criteria . ( Clinical Trials.gov number , NCT00617084 . Background — Outcomes remain relatively unfavorable for stent-based coronary intervention of lesions with long diseased segments . This study compared sirolimus-eluting stents ( SES ) and paclitaxel-eluting stents ( PES ) for long coronary lesions . Methods and Results — The present r and omized , multicenter , prospect i ve study compared the use of long ( ≥32 mm ) SES with PES in 500 patients with long ( ≥25 mm ) native coronary lesions . The primary end point of the trial was the rate of binary in-segment restenosis according to follow-up angiography at 6 months . The SES and PES groups had similar baseline characteristics . Lesion length was 33.9±11.6 mm in the SES group and 34.5±12.6 mm in the PES group ( P=0.527 ) . The in-segment binary restenosis rate was significantly lower in the SES group than in the PES group ( 3.3 % versus 14.6 % ; relative risk 0.23 ; P<0.001 ) . In-stent late loss of lumen diameter was 0.09±0.37 mm in the SES group and 0.45±0.55 mm in the PES group ( P<0.001 ) . In patients with restenoses , a pattern of focal restenosis was more common in the SES group than in the PES group ( 100 % versus 53.3 % , P=0.031 ) . Consequently , SES patients had a lower rate of target-lesion revascularization at 9 months ( 2.4 % versus 7.2 % , P=0.012 ) . The incidence of death ( 0.8 % in SES versus 0 % in PES , P=0.499 ) or myocardial infa rct ion ( 8.8 % in SES versus 10.8 % in PES , P=0.452 ) at 9 months of follow-up was not statistically different between the 2 groups . Conclusions — For patients with long native coronary artery disease , SES implantation was associated with a reduced incidence of angiographic restenosis and a reduced need for target-lesion revascularization  compared with PES implantation OBJECTIVES For patients with sirolimus-eluting stent ( SES ) restenosis requiring reintervention , we compared a strategy of repeat SES ( Cypher , Cordis , Miami Lakes , Florida ) implantation with paclitaxel-eluting stent ( PES ) ( Taxus , Boston Scientific , Natick , Massachusetts ) implantation . BACKGROUND Despite their high anti-restenotic efficacy , the widespread utilization of SES therapy has led to a significant absolute number of patients presenting with SES treatment failure . The optimal treatment strategy for such patients remains unclear . METHODS The ISAR-DESIRE 2 ( Intracoronary Stenting and Angiographic Results : Drug Eluting Stents for In-Stent Restenosis 2 ) study was a r and omized , open-label , active-controlled trial conducted among 450 patients with clinical ly significant in-SES restenosis at 2 centers in Munich , Germany . After pre-treatment with 600 mg clopidogrel , all patients were r and omly assigned to either SES or PES implantation . The primary end point was late lumen loss , based on in-stent analysis , at 6- to 8-month follow-up angiography . Secondary end points were binary angiographic restenosis ( diameter stenosis > 50 % ) at 6- to 8-month follow-up , target lesion revascularization , the composite of death or myocardial infa rct ion , and definite stent thrombosis at 12 months . RESULTS Regarding anti-restenotic efficacy , there were no differences between SES and PES in late loss ( 0.40 + /- 0.65 mm vs. 0.38 + /- 0.59 mm ; p = 0.85 ) , binary restenosis ( 19.6 % vs. 20.6 % ; p = 0.69 ) , or target lesion revascularization ( 16.6 % vs. 14.6 % ; p = 0.52 ) . In terms of safety outcomes , the rates of death/myocardial infa rct ion ( 6.1 % vs. 5.8 % ; p = 0.86 ) and stent thrombosis ( 0.4 % vs. 0.4 % ; p > 0.99 ) were also similar . CONCLUSIONS In cases of SES restenosis , treatment with either repeat SES or switch to PES was associated with a comparable degree of efficacy and safety . Drug resistance at an individual patient level may play a contributory role to the somewhat higher than expected late loss observed with the SES in the current study . ( Intracoronary Stenting and Angiographic Results : Drug-Eluting Stents for In-Stent Restenosis 2 [ ISAR-DESIRE 2 ] ; NCT00598715 ) OBJECTIVES The goal of this work was to verify whether the superiority of the sirolimus-eluting stent ( SES ) in inhibiting neointimal hyperplasia could be demonstrated in complex coronary lesions . BACKGROUND Both the SES ( Cypher , Cordis , Miami Lakes , Florida ) and the paclitaxel-eluting stent ( PES ) ( Taxus , Boston Scientific , Natick , Massachusetts ) have shown a marked reduction in neointimal hyperplasia compared with bare-metal stents . Intravascular ultrasound ( IVUS ) is the best method to assess arterial response to stent deployment , but few IVUS data are available comparing complex lesions treated with SES or PES . METHODS We prospect ively r and omized patients with complex lesions to SES or PES implantation . Intravascular ultrasound and quantitative angiography were performed post-procedure and at 9 months . Mean neointimal hyperplasia area ( NIHA ) , percent of NIHA ( NIHA% ) , mean peristent plaque area ( PSPA ) , and percent of PSPA ( PSPA% ) were calculated . The primary end point was NIHA% at follow-up . Secondary end points included change in PSPA% and angiographic late luminal loss at follow-up . RESULTS Of the 100 patients enrolled , 42 receiving the SES and 43 receiving the PES had adequate IVUS assessment . Vessel , plaque , and lumen areas were comparable at follow-up , but NIHA% was significantly lower with SES than PES ( 7.4 + /- 4.2 % vs. 15.4 + /- 8.1 % ; p < 0.001 ) . A significant reduction in PSPA% was observed with SES ( -4 + /- 10 % vs. 0 + /- 8 % ; p = 0.01 ) . Late loss was significantly lower with SES ( 0.16 + /- 0.19 mm vs. 0.32 + /- 0.33 mm ; p = 0.003 ) . CONCLUSIONS The SES shows a significantly higher inhibition of neointimal hyperplasia compared with PES in complex lesions . However , both stents have excellent IVUS and angiographic results at 9 months . A significant reduction in peri-stent plaque is observed only with SES AIMS This prospect i ve , r and omized study sought to directly compare the performance of paclitaxel and rapamycin on an otherwise identical , polymer-coated drug-eluting stent ( DES ) platform . METHODS AND RESULTS Stents with identical design and biodegradable polymeric coating that elute either rapamycin or paclitaxel over a 2 months time period were utilized . In this pilot trial that included 91 patients , both stent platforms proved safe with no case of death , Q-wave myocardial infa rct ion or stent thrombosis within a 9 months follow-up period . Late-lumen loss was markedly greater in the paclitaxel-eluting stent group compared with the rapamycin-eluting stent group ( 0.96 + /- 0.75 vs. 0.33 + /- 0.46 mm , P < 0.0001 ) . Likewise , the rate of angiographic restenosis was higher in the paclitaxel-eluting stent group compared with the rapamycin-eluting stent group [ 39.0 vs. 12.2 % ; relative risk ( RR ) 3.20 ( 95 % confidence interval , 1.29 - 7.92 ) , P = 0.005 ] . Concomitantly , the need for target lesion revascularization was higher in the paclitaxel-eluting stent group compared with the rapamycin-eluting stent group [ 26.7 vs. 8.7 % ; RR 3.07 ( 1.07 - 8.80 ) , P = 0.02 ] . CONCLUSION The results of this clinical trial that is the first to directly compare the performance of paclitaxel and rapamycin on a DES platform otherwise identical in design and polymeric coating imply that rapamycin is more effective for the prevention of coronary restenosis on a DES platform with mid-term drug release and less dependent on release kinetics than paclitaxel . Thus , to ensure efficacy , drug release from a paclitaxel-coating stent platform must be prolonged and well controlled to achieve results that are comparable with the FDA -approved paclitaxel-eluting stent platform Background — Although drug-eluting stents ( DESs ) constitute a major achievement in preventing restenosis , concerns remain regarding the increased inflammatory and thrombogenic responses associated with the polymers used . Recently , we showed that a nonpolymer on-site coating with rapamycin not only is feasible and safe but also leads to a dose-dependent reduction in restenosis . Methods and Results — To assess whether polymer-free stents coated on-site with 2 % rapamycin solution are inferior to polymer-based paclitaxel-eluting stents for the prevention of restenosis , we r and omly assigned a total of 450 patients with de novo lesions in native coronary vessels , excluding the left main trunk , to either the  polymer-free , rapamycin-coated Yukon DES ( rapamycin stent ) or the polymer-based , paclitaxel-eluting Taxus stent ( paclitaxel stent ) . The primary end point was in-stent late lumen loss . Secondary end points were angiographic restenosis and target lesion revascularization . The study was design ed to test the noninferiority of the rapamycin stent compared with the paclitaxel stent with respect to late lumen loss according to a noninferiority margin of 0.13 mm . Follow-up angiography was completed in 81 % of the patients . The mean difference in in-stent late lumen loss between the rapamycin-stent group and the paclitaxel-stent group was 0.002 mm , and the upper limit of the 1-sided 95 % confidence interval was 0.10 mm ( P=0.02 from test for noninferiority ) 
    Output:
    
LLL remained significantly associated with BAR and TVR after multivariable adjustment .
Reference vessel diameter and diabetes mellitus were inversely related to BAR .
CONCLUSIONS LLL is a strong , monotonically related predictor of BAR and TVR .
There is no evidence of threshold phenomenon in these relationships