BACKGROUND: There is some controversy on long-term cardiac outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in chronic renal failure (CRF). We compared cardiac adverse events after SES and PES implantation in patients with CRF over a period of 5 year. CRF was defined as serum creatinine concentration over 1.5mg/dL at baseline level METHODS: A total of 116 patients with CRF treated with SES (n = 67) or PES (n = 49) were consecutively enrolled in the KOMATE registry from 2003 to 2004. We assessed major adverse cardiac events (MACEs, cardiovascular death, nonfatal myocardial infarction, ischemia driven target vessel revascularization) and stent thrombosis (ST) according to the definitions set by the Academic Research Consortium. RESULTS: The mean follow-up duration was 62 +/- 8 month (at least 58 month and up to 77 month). The 5-year MACE rate did not show a significant difference between the two groups [9 (13.4%) in SES vs. 8 (16.3 %) in PES, P = 0.641]. The definite and probable ST at 5 year were similar in both SES and PES [5 (7.5 %) in SES vs. 7 (12.2 %) in PES, P = 0.385]. ST was increased significantly after 3 year in both groups. ST until 3 year was [2 (3.0 %) in SES vs. 2 (4.1 %) in PES, P = 0.749]. There were no differences in hazard ratio for MACE and ST between two stents. CONCLUSIONS: The present study demonstrated that long-tem cardiac outcomes including ST were not significantly different between SES and PES in patients with CRF. Very late ST was appeared with similar incidence in both groups.