Background: Although drug-eluting stent (DES) limits in-stent restenosis (ISR) and target vessel revascularization, their application in acute myocardial infarction is unclear. Specific DES comparisons with BMS for patients with acute MI remains controversial. We investigated the safety and efficacy of DES in patients with acute myocardial infarction (MI) and compared them with those of bare-metal stents (BMS) in routine clinical practice. Methods: We recruited patients from 50 high-volume centers with facilities for primary percutaneous coronary intervention (PCI). All were participants in the Korea Acute MI Registry (KAMIR) from Nov 2005 to Dec 2006. Patients who received at least one DES (n=5,563) were retrospectively compared with patients who received at least one or more BMS (n=478) during one-year clinical follow-up. Results: Patients receiving DES had more diabetes mellitus, more left anterior descending coronary lesions, and had lower left ventricular ejection fractions. At one-year, composite major adverse cardiac events (MACE) were 10.5 % in DES- and 18.0 % in BMS-treated patients (p<0.001). The one-year rate of target lesion revascularization was 1.5 % in DES- and 4.5 % in BMS- treated patients (p<0.001) and the one-year rate of re-PCI was 3.9 % in DES- and 6.8 % in BMS-treated patients (p=0.002). In multivariate analysis of all clinical and angiographic parameters, multi-vessel disease, use of BMS, door to balloon time were the only independent predictors of one-year MACE. Conclusion: The use of DES in patients with acute MI was safe and associated with better one-year clinical outcomes than that of BMS, mainly due to the decreased re-PCI.