Background; Clinical implication of positive peristent vascular remodeling (PPVR) after drug-eluting stent (DES) implantation is not well defined. Method; A total of 226 patients (sirolimus-eluting stent, SES, n= 105; paclitaxel-eluting stent, PES, n= 121) from the POET trial who underwent post-intervention and 9-month follow-up intravascular ultrasound were followed clinically for 5 years. PPVR was arbitrarily defined as >10% increase in external elastic membrane volume index at follow-up. We investigated long-term outcomes of the patients with and without PPVR. Result; Percent neointimal volume obstruction was significantly smaller with SES than with PES (1.9짹3.5% vs. 9.6짹9.8%, p< 0.001). However, PPVR (39.0% vs. 24.8%, p= 0.015), and late acquired stent malapposition (LASM) (20.0% vs. 9.1%, p= 0.015) occurred more frequently with SES than with PES. The 5-year major adverse cardiac event rate did not differ between the patient group with and without PPVR. However, late or very late stent thrombosis (ST) was observed more frequently in patients with PPVR than those without PPVR (15% vs. 2%, p= 0.009). Early discontinuation (<1 year) of dual antiplatelet therapy [hazard ratio (HR) = 17.86 (3.60-88.59), p< 0.001], LASM [HR= 5.61 (0.97-15.19), p= 0.041] and PPVR [HR =10.36 (1.27-84.28), p=0.029] were identified as risk factors of late or very late ST. Conclusion; The present study demonstrates development of PPVR and LASM after implantation of DES are important risk factor of late or very late ST along with early discontinuation of dual antiplatelet therapy. Key words: drug-eluting stent, positive peristent vascular remodeling