OBJECTIVE: The aim of this study is to compare the efficacy and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with acute ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The use of DES for STEMI may be associated with stent thrombosis and increased clinical events. The results of recent randomized trials of DES in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI are not consistent. METHODS: Employing data from the Korea Acute Myocardial Infarction Registry (KAMIR; from November 2005 to June 2007), a total of 2,279 patients with STEMI who underwent primary PCI for a single-vessel, infarct-related artery with diameter ���2.5 and ���3.5 mm and lesion length ���13 and ���25 mm were grouped according to stent type inserted: DES group (N=2,024; 1,520 men; 63짹12 years of age) and BMS group: (N=255; 180 men; 65짹12 years of age). The primary study end point was the composite of death, myocardial infarction, target lesion revascularization (TLR) at one, six and 12 months after PCI. RESULTS: Patients in the BMS group were older than those in the DES group (63.0짹12.9 vs. 65.7짹12.7 years of age, p=0.001). Diabetes was more prevalent in the DES group (24% vs. 17%, p=0.015), while dyslipidemia was more prevalent in the BMS group (8% vs. 16%, p<0.0005). In-hospital and 30-day mortality rates were higher in the BMS group than in the DES group (3.8% vs. 7.1%, p=0.012; 0.9% vs. 3.3%, p=0.007, respectively). At 6 months, the primary outcome occurred in 7.4% of patients with DES and 14.2% of patients with BMS (p=0.001). Death and TLR rates were significantly lower in the DES group (2.1% vs. 4.9%, p=0.015; 1.6% vs. 7.4%, p<0.0005, respectively). Likewise, 12-month mortality and TLR rates were significantly lower in the DES group, compared with BMS group (3.6% vs. 7.5%, p=0.026; 3.1% vs. 10.0%, p<0.0005, respectively). There was no difference in the incidence of subacute or late stent thrombosis between the two groups. CONCLUSIONS: Use of DES for acute STEMI is safe and improves clinical outcomes by reducing the risk of death and re-intervention, compared with BMS.