Background: Clinical and angiographic outcomes regarding the safety and effectiveness of using drug-eluting stents in acute myocardial infarction (AMI) are limited. We compared clinical and angiographic outcomes of sirolimus-eluting stents (SESs) versus paclitaxel-eluting stents (PESs) for the treatment of AMI. Methods: The first 310 consecutive patients treated with SESs in the setting of primary percutaneous intervention for AMI were compared with the first 55 consecutive patients treated with PESs in this single center PCI registry from April 2003 to June 2006. The follow up coronary angiography was available in 212 patients (58.1%, 174 patients with SES and 38 patients with PES). Results: The 6 months follow-up late lumen loss was significantly lower in the SES Group (0.21 짹 0.50 vs. 0.41 짹 0.55 mm, p=0.05); however, binary restenosis (ISR) were similar between the 2 groups [12 patients (6.9%) with SES and 4 patients (10.5%) with PES, p=0.496]. All ISR patterns were focal type (4 patients with IB margin type, 7 patients with IC focal body type, and 1 patient with ID multifocal type) in the SES Group compared with only 50% of focal type (1 patient with IB type and 1 patients with IC type) of ISR in the PES Group (p=0.033). Patients with ISR were treated either with SES implantation (8 patients in the SES Group and 4 patients in the PES Group) or cutting ballooning (1patient in the SES Group). Acute thrombosis [2 patients (0.6%)] and late thrombosis [1 patient (0.3%)] were observed only in the SES Group whereas no stent thrombosis was found in the PES group (p=1.000). Major adverse cardiac events (cardiac death, MI, target lesion revascularization) revealed no significant differences between the 2 groups during the average of 18 months of follow-up [12 patients (5.5%) with SES vs. 5 patients (10.6%) with PES, p=0.196]. Conclusion: Although the follow-up late lumen loss was significantly lower in the SES Group, no significant differences in the rates of ISR and major adverse cardiac events were observed. Both SESs and PESs were effective and safe for the treatment of AMI in this single center registry.