OBJECTIVES: To evaluate long-term clinical outcomes of elderly Medicare beneficiaries who underwent non-emergent coronary stenting. METHODS: This population-based prospective study analyzed patients in a large nationally representative administrative claims database. The sample consisted of Medicare patients aged 65+ who underwent a non-emergent coronary stent between 2006 and 2010. Patients were identified by existence of a hospital claim for a bare metal stent (ICD-9-CM procedure code 36.06) or drug-eluting stent (ICD-9-CM procedure code 36.07 or codes 36.06 and 36.07). Eligible patients were followed one to five years after stenting to assess risk of revascularization, myocardial infarction (MI), coronary artery bypass surgery (CABG), and death. Long-term clinical outcomes were based on HEDIS 2010 technical specifications. RESULTS: The study population included 26,023 patients that underwent a coronary bare-metal stent (female = 40.15%, age = 75.38 (± 6.66), history of MI = 7.97%, history of CABG = 1.01%) and 74,448 patients that underwent a coronary drug-eluting stent (female = 40.17%, age = 73.78 (± 6.19), history of MI = 7.39%, history of CABG = 1.27%).  Patients with drug-eluting stents had a lower risk of revascularization (29.57% vs. 31.65%, p <0.001), CABG (1.40% vs. 2.57%, p <0.001), and mortality (4.96% vs. 9.25%, p <0.001) within one year follow-up after stenting. There was no significant difference in the risk for MI within one to four years follow-up (3.35% vs. 3.29%, p > 0.05), but there was a significant difference in risk of MI at five year follow-up (7.33% vs. 3.36%, p <0.001).  Mortality rates significantly increased over time in patients with a bare-metal stent while mortality rates for those with a drug-eluting stent remained relatively stable. CONCLUSIONS: The use of drug-eluting stents was significantly correlated with a decline in long-term risk of revascularization, CABG, MI and death in comparison to bare-metal stents.