Background: There were no published data regarding the clinical efficacy and safety of third generation drug-eluting stent (everolimus-eluting stent, EES) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). Methods: This study was aimed to establish the clinical outcomes of PCI with EES compared to first generation DES (sirolimus-eluting stent, SES and paclitaxel-eluting stent, PES) and second generation DES (zotarolimus-eluting stent, ZES) for primary PCI in STEMI. A prospective, open-labeled, multi-center cohort has been performed at 3 centers in Korea. All patients will be clinically followed-up for two years. The primary endpoint was major adverse cardiac event (MACE): the composite of cardiac death (CD), recurrent MI and ischemia-driven target lesion revascularization (TLR)) at three months. Stent thromboses (ST) by ARC definition were analyzed. Results: Total 675 patients (EES=64, ZES=202, SES=204, PES=205) who were completed more than three month were analyzed. Three-month MACE were 1.6%, 3.4%, 3.0% and 3.0% in EES-, ZES-, SES- and PES-group, respectively (p=ns). Cardiac death was 1.6%, 2.9%, 1.0% and 1.0% in EES-, ZES-, SES- and PES-group, respectively (p=ns). ST was 0%, 2.0%, 1.5% and 1.0% in EES-, ZES-, SES- and PES- group, respectively (p=ns). Conclusions: Campared to second generation DES (ZES) and first generation DES (SES and PES), third generation DES (EES) showed equivalency in terms of MACE and ST through three-month clinical follow-up in patients following primary PCI.