Background Multivessel disease (MVD) occurs in substantial patients with acute myocardial infarction at presentation. Although, multivessel percutaneous coronary intervention (PCI) with bare-metal stent in those patients was associated with worse clinical outcomes, its clinical efficacy remains controversial in the era of drug-eluting stent. Methods Among 2,247 patients registered in the Korea Working Group of Myocardial Infarction (KorMI) from January 2008 to July 2008, 855 patients with ST-segment elevation myocardial infarction (STEMI) underwent primary PCI. MVD (at least 2 vessels with ���50% stenosis) was found in 467 patients (55%). Patients with MVD were divided in 2 groups based upon the revascularization strategy: multivessel PCI group (n=151) versus culprit-only PCI group (n=316). We evaluated in-hospital mortality and 1-month major adverse cardiac events (MACEs: composite of death, non-fatal MI, and any revascularization). Results Baseline characteristics were not significantly different between 2 groups except body mass index (24.9짹3.9 in multivessel PCI group versus 23.7짹3.0 in culprit-only PCI group, P=0.02). Angiographic findings such as culprit vessel, lesion type, and baseline Thrombolysis In Myocardial Infarction grade were not significantly different between 2 groups. Drug-eluting stents were used in 92% of patients with MVD. Total in-hospital mortality rate was 7.5%. Multivessel PCI group showed a tendency to have a lower in-hospital mortality, which was not statistically significant (4.6% in multivessel PCI group versus 8.9% in culprit-only PCI group, P=0.10). Follow-up data at 1-month were available in 234 patients (50%). The rate of MACEs at 1-month was not significantly different between multivessel PCI group and culprit-only PCI group (13.0% versus 17.6%, P=0.39). Conclusion In the drug-eluting stents era, multivessel PCI in STEMI patients with MVD can be considered as 1 of treatment option.