BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (PCI) has been reported to be effective reperfusion therapy for acute myocardial infarction (AMI). In the very thrombotic environment of AMI, primary PCI, with heparin-coated stents, has been known to reduce the early reocclusion of the stented vessel by preventing thrombosis. However, little data exist regarding the long-term clinical outcomes. The aim of our study was to evaluate the safety, feasibility and long-term efficacy of heparin-coated stents in AMI. SUBJECTS AND METHODS: Between January 1998 and July 2002, primary PCI with heparin-coated stents was performed in 132 consecutive patients (98 males, with a mean age of 56.3+/-0.7 years) admitted with the diagnosis of AMI within 12 hours from the onset of the chest pain. Major adverse cardiac events (MACE), including death, MI, TLR (target lesion revascularization) and CABG, were recorded during hospitalization and the follow-up period. Angiograms were obtained at the baseline, after stent implantation and at 6 months following implantation. RESULTS: The angiographic and procedure success rate was 96.2%. During hospitalization, there was no evidence of reocclusion of stented vessel, but 1 patient underwent a repeat PCI due to dissection. There were no bleeding complications. A six-month angiographic follow-up was completed in 47.2% of eligible patients and binary restenosis was present in 20.1%. During the long-term clinical follow-up (mean follow-up period 37.2+/-7.2 months), there were 12 deaths, 1 myocardial infarction and 18 TLR. The MACE free survival rate was 76.5%. CONCLUSION: Primary PCI, with heparin-coated stents, shows favorable long-term clinical outcomes.