Background The gender-based differences in adverse events after drug-eluting stent (DES) implantation between Chinese women and men have not been fully studied.The present study aimed to compare the 5-year clinical outcome after DES implantation in Chinese women and men.Methods Chinese women (n=298) and men (n=698) with newly diagnosed de novo coronary lesions were studied after DES implantation.The primary endpoint was the occurrence of major adverse cardiac events (MACEs) over a 5-year follow-up,including myocardial infarction (MI),cardiac death,and target vessel revascularization (TVR).Propensity score matching (PSM) was used to compare the adjusted MACE rates between sexes.Results Women differed in body habitus and had increased fasting cholesterol.Fewer women presented with MI,and they had better cardiac function with less complex disease.The unadjusted rate of MI at 3 years (2.1％) and 5 years(5.0％) and MACE (25.2％) at 5 years in men was significantly higher than that of women (0.3％,1.0％ and 17.8％,P=0.050,P=0.032,and P=0.011,respectively).After PSM,the adjusted adverse events between sexes were similar.The stent thrombosis rate rapidly increased after 2 years in men.Conclusions There were significant gender-based differences in baseline characteristics.Chinese men had equivalent outcomes to women after DES after adjustment by PSM.The increased rate of MI in men was attributed to an increased unadjusted rate of MACE.