Background: Drug-eluting stent (DES) has been widely utilized in the interventional cardiology. However, long coronary lesions remains at high risk of adverse cardiac events after DES implantation. Up to date, comparison of long-term clinical outcomes between sirolimus-eluting stent (SES) with paclitaxel-eluting stent (PES) in long coronary lesions has not been sufficiently evaluated. Methods: This randomized, multicenter, prospective study compared the use of long (���32 mm) SES with PES in 500 patients with long (���25 mm) native coronary lesions. This study compared long-term (2-year) clinical outcomes of sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) for long coronary lesions. Results: The SES and PES groups had similar baseline characteristics. The lesion length was 33.9짹11.6 mm in the SES and 34.5짹12.6 mm in the PES group (p=0.527). At 2 years, Incidences of death (2.0% in SES vs. 1.2% in PES, p=0.724) or myocardial infarction (0.8% in SES vs. 0.4% in PES, p=0.999) were not statistically different between the two groups. However, SES patients had lower target lesion revascularization rate (2.8% vs. 9.6%, p=0.002) compared to PES patients. Two-year major adverse cardiac events (4.8% vs. 11.2%, p=0.008) including death, myocardial infarction, and target lesion revascularization was significantly reduced in SES patients versus PES patients, mainly driven by reduction of target lesion revascularization. Three stent thromboses (1 subacute, 1 late, 1 very late) developed during dual antiplatelet therapy in the SES patients and none in the PES patients. Conclusions: For patients with long native coronary artery disease, SES implantation was associated with a reduced 2-year major adverse cardiac events and target lesion revascularization compared to PES implantation.