Background Long-term clinical outcomes of first-generation drug-eluting stent (DES) were unknown. The aim of this study was to compare clinical outcomes for seven years between sirolimus-eluting stent (SES) and bare-metal stent (BMS). Materials and Methods During the transition period form BMS to DES (from April 2002 to April 2004), 434 consecutive patients with 482 lesions performed percutaneous coronary intervention (PCI) using BMS or SES. From these, propensity score matched BMS (n=186) and SES (n=166) patients were selected and enrolled in this study. Seven year clinical outcomes of major adverse cardiac events (MACE) in terms of cardiac death, myocardial infarction, target lesion revascularization (TLR) and target vessel revascularization (TVR) were analyzed. Also, stent thrombosis (ST) was assessed. Results Baseline characteristics between two groups were not different. Cumulative MACE for 7 years was 33.9% in BMS and 28.9% in SES and it was not statistically significant (p=0.318). There were no statistical differences in MI (4.3% in BMS vs. 3.6% in SES, p=0.751), TLR (11.8% in BMS vs. 12.7% in SES, p=0.814), TVR (15.6% in BMS vs. 16.3% in SES, p=0.863), cardiac death (2.2% in BMS vs. 0.6% in SES, p=0.220) and ST (1.1% in BMS vs. 1.8% in SES, p=0.562). Compared with BMS, SES was associated with lower rate of MACE at the 1 year (9.7% in BMS vs. 3.6% in SES, p=0.024). However, there was no significant difference in MACE between 1 and 7 years. SES showed more higher rate of TLR and TVR than BMS between 1 and 7 years. Conclusions Long-term follow-up outcomes of first-generation DES didn���t show significant differences in total MACE until 7 years compared with BMS. However these stents showed different event rate according to the time period. Therefore, further long-term follow up study will be still needed. Key Words: Drug-eluting stent; Bare-metal stent, long-term