To evaluate the efficacy of the more flexible ACS Multi-Link stent, a prospective angiographic follow-up study was performed. Implantation of the ACS Multi-Link stent was attempted in 70 consecutive patients with 79 coronary lesions from April to November 1995. Clinical success defined as final % diameter stenosis of < 50% without death, bypass surgery or Q-wave myocardial infarction was achieved in 95% of the patients. There was 1 in-hospital death due to acute pulmonary embolism. In-hospital subacute stent occlusion occurred in 2 cases. Follow-up angiograms were obtained in 62 (83%) eligible lesions. The minimal luminal diameter improved from 0.97 +/- 0.41 to 2.72 +/- 0.30 mm, but started to decrease at 1 month (2.38 +/- 0.42 mm), and continued to decrease throughout the 6 months (1.96 +/- 0.41 mm). Angiographic restenosis (stenosis ³ 50%) occurred in 16% of the lesions, a rate smaller though not significantly different from the 25% with the Palmaz-Schatz stent. A revascularization procedure of the target lesion was required in 6% of the patients. Multivariate analysis identified lack of post-dilatation, type of lesion, lesion length and pre-procedural reference diameter to be predictors of angiographic restenosis. In conclusion, the ACS Multi-Link stent can be implanted successfully with a low complication rate and a clinical outcome at least comparable to the Palmaz-Schatz stent.