 The effectiveness, safety, and deliverability of second generation drug eluting stents DES, including Xience V, will need to be examined in real world patients to provide the same level of evidence base and comfort that has accompanied the use of the first generation devices. Randomized clinical trials provide the fairest evaluation of outcomes by controlling for confounding patient and procedural characteristics; however, randomized clinical trials also exclude the very high risk patients that account for upwards of 80 of real world patient populations such as those at Wake Forest University Baptist Medical Center WFUBMC. 