Background: Many observational and randomized studies have suggested that women have a higher short-term mortality after acute myocardial infarction (AMI) following primary percutaneous coronary intervention (PCI). However, little is known about the effect of gender differences on short- and long-term outcomes in the drug-eluting stent (DES) era. Methods and results: To evaluate the clinical outcomes of women who have undergone PCI with DES, we analyzed 3,298 consecutive eligible patients using the Korea Acute Myocardial Infarction Registry (KAMIR). No differences in primary PCI success rates were found between women and men. On univariate analysis, women showed worse outcomes than men for one-month major adverse cardiac event (MACE) (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.81-2.92) and 12-month MACE (OR, 1.64; 95% CI, 1.36-1.97). On multivariable analysis, older age (OR, 1.03; 95% CI, 1.02-1.05), dyslipidemia (OR, 2.28; 95% CI, 1.16-4.49), smoking (OR, 1.54; 95% CI, 1.07-2.21) and Killip class (OR, 3.63; 95% CI, 2.76-4.91), but not gender, were associated with one-month MACE in this national registry. In 12-month MACE, old age, ischemic heart disease history, diabetes, dyslipidemia, and Killip class were independent predictors of patients undergoing primary PCI with DES. Conclusion: Older age and additional comorbidities, but not gender, are likely to explain the deteriorating short-and long-term outcomes in the DES era.