Background and Objectives: Sirolimus-eluting stents (SES) have demonstrated improved clinical outcomes of patients with end-stage renal disease (ESRD). However, patients with ESRD had multi-factorial risks and revealed diverse down-hill clinical courses, such as myocardial infarction (MI) or death on long-term follow-up. The aim of this study was to evaluate the long-term outcomes following SES implantation in patients with ESRD. Subjects and Methods: We analyzed the data on 627 consecutive patients who underwent SES implantation in our registry between April 2003 and June 2005. Major adverse cardiac events (MACE), defined as MI, death, or target vessel revascularization (TVR), were compared between patients with ESRD (ESRD group) (n=50) and with normal renal function (non-ESRD group) (n=577). Results: Baseline characteristics revealed a higher prevalence of hypertension (94% vs. 60%, p=0.001), diabetes (76% vs. 36%, p=0.001), and multi-vessel diseases (84% vs. 67%, p=0.02). There was no significant difference in reference vessel diameter (RVD) between groups. However, the lesion length of the ESRD group were longer than those of non-ESRD group (25.6짹7.0 mm vs. 20.2짹8.8 mm, p<0.001). At follow-up (mean 26 짹 9 months), overall MACE rate of the ESRD group was 11.5%, which was not statistically different with non-ESRD group (10.0%, Kaplan-Meier analysis, Log rank test, p=0.101). However, the ESRD group had a higher mortality rate than non-ESRD group (8.0% vs. 2.1%, p=0.033). There was no difference in the incidence of MI, TVR, or non-target vessel TVR. Conclusion: SES implantation in patients with ESRD showed acceptable and favorable long-term clinical outcomes in our registry, compared with patients with normal kidney function. However, SES implantation could not reduce the mortality rate of patients of ESRD.