Background: Multiple overlapping drug-eluting stents (DESs) have been used increasingly to treat diffuse coronary disease, but the safety and efficacy of this approach remains unclear. Methods and Results:We assayed clinical and angiographic outcomes after placement of ���full metal jacket��� stents (stented length ��� 60mm) in 347 consecutive patients (352 lesions) with very long de novo coronary lesions. The mean age was 61.0짹10.1 years, and the mean stented length was 71.9짹13.7mm. The procedural success rate was 97.7%. Major in-hospital complications (1 death, 2 acute stent thrombosis) occurred in 3 patients (0.7%). Angiographic follow-up data obtained for 230 (234 lesions) of the 328 eligible patients (70.1%) showed that the restenosis rate was 13.7%. Multivariate analysis found that reference artery diameter (OR 0.05; 95%CI, 0.01-0.33; p=0.002) and use of Taxus stents (OR 2.88; 95% CI, 1.03-8.04; p=0.043) were significant predictors of restenosis. During follow-up (16.6짹6.9 months), there were 9 deaths (6 cardiac, 3 noncardiac), 1 nonfatal myocardial infarction, and 13 target lesion revascularizations. The cumulative probability of survival without major adverse cardiac events (cardiac death, Q-wave myocardial infarction and target lesion revascularization) was 95.4짹1.1% and 91.4짹2.1% at 1 and 2 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was the only predictor of stent thrombosis (HR 18.24; 95% CI, 1.65-201.19; p=0.018) and cardiac death/Q-wave myocardial infarction (HR 5.37; 95% CI, 1.28-22.49; p=0.021). Conclusion: full metal jacket DESs may be a safe and effective method to treat diffuse coronary disease and may be a useful treatment option for complex long lesions.