Backgrounds: The long-term efficacy and safety of zotarolimus-eluting stent (ZES) has not been proved in patient with STEMI who are undergoing primary percutaneous coronary intervention (PCI) as compared with sirolimus-eluting stent (SES) or bare metal stent (BMS). Methods and results: We evaluated consecutive 2,456 patients with STEMI underwent primary PCI by means of Korea Acute Myocardial Infarction Registry. Median follow up period is 343 days (range 1-455). Number of the patients used SES is 1727, ZES is 447 and BMS is 282. Among three groups there were a few differences such as previous ischemic heart disease history, stent length and stent diameter (ZES 7.2% vs. SES 10.3% vs. BMS 12.8%, P=0.037, 23.82 짹 5.460 vs. 26.21 짹 6.282 vs. 22.00 짹 5.513, P<0.0001, 3.23 짹 0.459 vs. 3.13 짹 0.344 vs. 3.48 짹 0.267, P<0.0001, respectively). And SES was more often implanted when performing intervention of left anterior descending artery (SES 76.0% vs. ZES 17.1% vs. BMS 6.9%, P<0.0001). In cox regression analysis, using ZES or SES was independently associated with the incidence of major adverse cardiac event (MACE) (Hazard ratio 0.591, 95% confidence interval 0.440-0.793, P=0.002). The using of ZES or SES showed lower incidence of MACE (figure1), cardiac death and target vessel revascularization with target lesion revascularization (ZES 8.0% vs. SES 7.3% vs. BMS 14.0%, P<0.0001, 4.6% vs. 4.5% vs. 8.0%, P=0.012, 3.2% vs. 2.3% vs. 5.1%, P=0.009, respectively). Conclusions: In patients with STEMI who received primary PCI, implantation of ZES significantly reduced long-term MACE and showed similar outcomes as compared with SES.