Background: Although drug-eluting stents (DES) has significantly reduced the rate of angiographic restenosis compared with bare-metal stents, percutaneous coronary intervention of long coronary lesions are still challenging in the current era. Methods: We performed subgroup analysis of patients with very long coronary lesions (lesion length���28 mm) in the ZEST trial comparing second-generation zotarolimus-eluting stents with first-generation sirolimus- and paclitaxel-eluting stents. The primary end point was composite major adverse cardiac events (MACE) of death, myocardial infarction (MI), or ischemic-driven target vessel revascularization at 12 months. Results: A total of 960 patients with very long coronary lesions were treated with zotarolimus-(ZES, 322 patients), sirolimus-(SES, 317 patients), or paclitaxel-eluting stents (PES, 321 patients). Baseline demographic, angiographic, and lesion characteristics were comparable among the groups. At 12 months, for the primary end point, SES group was significantly lower rate of the MACE than ZES group (9.5% vs. 15.2%, p=0.03) and PES group (9.5% vs. 17.1%, p=0.004) (Table 1). At 9 months, the rates of in-segment restenosis were significantly lower in the SES (2.4%) group than the ZES group (13.4%) and the PES group (13.9%) (Table 2). Conclusion: For patients with very long coronary artery disease, SES implantation had favorable clinical and angiographic outcomes as compared with ZES and PES implantation.