Background: Limited information is available on outcomes in patients with acute myocardial infarction (AMI) caused by left main coronary artery (LMCA) with drug eluting stents (DES). Methods: We compared of short-term and long-term outcomes between sirolimus-eluting stents (SES) (n=59) and paclitaxel-eluting stents(PES) (n=44) in patients with AMI caused by LMCA as a culprit lesion who were enrolled in Korean Acute MI Registry (KAMIR) and followed up at least one-year. Results: Clinical characteristics of both groups were similar. The success rate of percutaneous coronary intervention (PCI) was similar (96.6% vs. 100.0%, p=0.213) and 1 PES group patient had coronary artery bypass graft (CABG) at 6 month. Angiographic characteristics were not different except that SES group had longer lesion length (23.4짹6.7% vs. 20.4짹6.5%, p=0.028). 1 month major adverse cardiac events (MACE) were similar between two groups. At 12 month, re-PCI (8.5% vs. 9.1%, p=0.913), target lesion revasculization (TLR) (5.1% vs. 6.8%, p=0.710) and total MACEs (28.8% vs. 31.8%, p=0.742) were also comparable between groups. Higher Killip class (OR=3.64, 95%CI: 1.23-10.75, p=0.019), complex lesion type (OR=2.83, 95%CI: 0.88-9.11, p=0.082), post-procedural TIMI flow grade < 3 (OR=9.31, 95%CI: 1.26-68.82, p=0.029) were the the independent predictor of 1-year MACE. Conclusions: Mortality and MACEs in patients with AMI caused by LMCA as culprit lesion were still high. SES and PES implantation had similar clinical outcomes.