Background: Sirolimus-eluting stents (SES) and Paclitaxel-eluting stents (PES) are the most widely used drug eluting stents (DES). But the comparison of the safety and efficacy is still controversial in patients with acute myocardial infarction (AMI) . Methods: We compared of long-term clinical outcomes between SES (n=265) and PES (n=1,139) in patients with AMI (n=1,404, 66.8짹11.6 years old, 1042 males) who visited our hospital between January 2004 and July 2006. They were followed up at least 3 years (mean duration: 32.6짹20.1 months). Primary end point was mortality and the composite of major adverse cardiac events (MACEs) including all cause mortality, myocardial infarction, target-vessel revasculization (TLR), and coronary artery bypass graft (CABG). Results: Clinical characteristics of both groups were not different. Angiographically, SES group involved more left anterior descending artery (66.4% vs. 55.2%, p<0.001) and left main artery (6.0% vs. 1.9%, p<0.001). PES group involved more right coronary artery (15.1% vs. 29.0%, p<0.001). Stent diameter (3.2짹0.3 vs. 3.2짹0.3 mm, p=0.070) was not different, but stent length (28.1짹6.0 vs. 26.2짹5.6 mm, p<0.001) was larger in SES group. Other angiographic findings were not different between the groups. In-hospital mortality rate was not different between the groups (0.8% vs. 2.0%, p=0.161). At 3-year, mortality rate (4.2% vs. 4.2%, p=0.779), TLR (9.8% vs. 7.1%, p=0.176), and MACEs (14.1% vs. 11.3%,p=0.231) were not different. Conclusions: SES and PES have similar long-term mortality rate. Also long-term clinical outcomes were similar between SES and PES implantation.