Background: The angiographic characteristics and prognosis in elderly women in relation to the therapeutic impact of sirolimus-eluting stents (SES) need to be clarified. Methods and Results: Quantitative coronary angiography analysis was performed in 1,374 patients with coronary artery disease: 670 patients were treated with a bare metal stent (BMS) and the remaining 704 were treated with SES. Patients were divided into 4 groups according to gender and age (<75 years M/F, ≥75 years M/F), and major adverse cardiovascular events (MACE) were compared among them. Women ≥75 years old tended to have 3-vessel disease with small vessel size and the incidence of MACE in this group was high in the BMS era. However, in the SES era, this prognosis improved by reducing all-cause death and target vessel revascularization. Conclusions: Using SES has a therapeutic advantage for the high-risk population of elderly women with angiographically unsuitable lesions for percutaneous coronary intervention. (Circ J 2009; 73: 1219-1227)