Background: Coronary bifurcation intervention is still challenging because of the continuing argument of technical issues and long-term durability even in the drug-eluting stent (DES) era. There are limited data regarding long-term safety and durability of sirolimus- and paclitaxel-eluting stent (SES & PES) for the bifurcation lesions. Methods: A total of 308 consecutive patients (pts) were randomly received first generation DES either SES (Cypher; n=160 pts, 183 lesions) or PES (Taxus; n=148 pts, 174 lesions). Pts with hybrid stenting and cardiogenic shock were excluded. Clinical outcomes up to 36 months were compared between the 2 groups. Results: The baseline clinical characteristics were balanced except more previous PCI in SES group (14.1% vs. 5.3%, p=0.013) whereas smoker (39.1% vs.51.1%, p=0.042) and AMI (17.3% vs. 30.3%, p=0.009) were higher in the PES group. At 6 months, binary restenosis tend to be lower (5.0 vs. 10.8%, p=0.057), follow up minimal luminal diameter was larger (MLD, 2.68짹0.68 vs. 2.13짹0.90, p=0.001) and late loss was lower (0.53짹0.56 vs. 0.91 짹 0.70, p=0.001) in the SES group. At 6 month, there was a trend toward less incidence of total death and major adverse cardiac events (MACE)s in the SES group, but these midterm angiographic and clinical benefit of SES were not maintained at 36 months (Table). Conclusions: The mid-term angiographic and clinical outcomes were superior in SES group compared with those of PES group in bifurcation lesion treatment, however, these benefits were not maintained up to 36 months, suggesting similar efficacy and durability of two major first generation DESs.