Background: Drug-eluting stents (DES) have been shown to reduce the incidence of restenosis and target vessel revascularization (TVR) in clinical randomized studies when compared with bare metal stents (BMS) in patients undergoing elective percutaneous intervention. Limited data are available with the use of DES in patients with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to compare the clinical outcomes of patients with acute STEMI treated with sirolimus-eluting stents (SES) vs. paclitaxel-eluting stents (PES). Methods and Results: We recruited 3,148 patients with acute STEMI from 50 high-volume centers with facilities for primary percutaneous coronary intervention (PCI). All were participants in the Korea Acute MI Registry (KAMIR) from Nov 2005 to Dec 2006. Patients who received at least one SES (n=1,784) were retrospectively compared with patients who received one or more PES (n=1,364) during one-year clinical follow-up. According to the propensity score matching, during one-year clinical follow-up, composite major adverse cardiac events (MACE) were 14.4 % in SES- and 17.4 % in PES-treated patients (p=0.154). The one-year rate of target lesion revascularization (TLR) was 2.7 % in SES- and 3.4 % in PES-treated patients (p=0.498). Conclusion: SES and PES had similar clinical outcomes in patients with acute STEMI during one-year clinical outcomes. Long-term follow-up will be needed for further analysis.