Background ; The treatment of left main coronary artery (LMCA) bifurcation lesion remains challenging. We compared the safety and efficacy of sirolimus-eluting (SES) and paclitaxel-eluting (PES) stent implantation for the treatment of LMCA bifurcation lesion. Methods ; One hundred fifteen patients who underwent stent implantation in a de novo LMCA bifurcation lesion with SES or PES, between Mar 2005 and Nov 2008, were enrolled. Patients with hemodynamic instability or primary percutaneous coronary intervention for myocardial infarction (MI) were excluded. Major adverse cardiac event (MACE) was defined as a composite of cardiac death, MI or target lesion revascularization (TLR). Results ; Ninety four patients were treated with SES and 21 patients with PES. Baseline characteristics were similar between the 2 groups. The stent thrombosis was noted in 1 case in the SES group. Angiographic follow-up (FU) was performed in 100 patients (87%) at a mean time of 273 짹 39 days. During a mean FU of 724 짹 394 days, the SES group had a lower MACE compared with the PES group (SES 10.6% versus PES 28.6%, P = 0.032). Late loss of the main vessel was significantly lower in the SES group (SES 0.34 짹 0.61 mm, PES 1.12 짹 0.61 mm, P < 0.001). Logistic regression analysis including diabetes mellitus, stent technique or stent type showed that stent type was the only predictor of MACE (Odds ratio of PES versus SES 4.83, 95% Confidence Interval = 1.34 – 17.38, P = 0.016). Conclusions ; In this study, SES implantation appears to have better long-term outcomes than PES for the treatment of LMCA bifurcation lesion.