Cobalt chromium stents (CCS) are seldom compared to drug-eluting stents (DES) for coronary intervention in published clinical trials. We evaluated the daily usage patterns of CCS in comparison to DES unconstrained by eligibility criteria. We compared consecutive patients (n = 303) with de novo lesions treated exclusively with a CCS to 432 patients treated exclusively with a DES. Patients in the CCS group were older, frequently had heart failure, renal failure, prior coronary balloon angioplasty, prior stroke, more comorbidities, and more multivessel disease than the DES group. The DES group had longer and more type C and left anterior descending (LAD) coronary artery lesions. The in-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target lesion revascularization (TLR)) were similar. At 6 months, the cumulative rate of MACE was 12.9% in the CCS group and 5.6% in the DES group (P < 0.001), and this was driven by TLR. The rates of stent thrombosis were similar in CCS (0.9%) and DES (1.0%) patients. In conclusion, the CCS were used in clinically higher risk patients, while DES were used in more severely diseased coronary arteries. Drug-eluting stent use resulted in lower rates of clinically driven repeat revascularization with similar rates of death, MI, stroke, and stent thrombosis.