Introduction: Drug eluting stent(DES) has well established benefit in management of acute coronary syndrome. But concerning clinical setting of acute thrombotic occlusion, some debate remained about clinical safety of drug eluting stent compared with bare metal stent(BMS). We aimed to verify safety and long term clinical outcome of DES for management of acute total occlusion of coronary artery. Methods: We enrolled 3564 patients (male 72.6%, Age 61짹12 yr) with acute ST elevation myocardial infarction who showed total coronary occlusion in coronary angiography and underwent primary PCI within 6 hrs from onset of symptom from KAMIR. We checked baseline clinical characteristics, laboratory findings, and angiographic data. Incidence of successful PCI, hospital death and the major advance cardiac events (MACE) during 1 year follow up according to stent type were analyzed. Results: There was no significant difference in baseline characteristics and laboratory data between DES and BMS group. The incidence of GpIIbIIIa inhibitor infusion was lower (9.5% vs. 17.8%, p=0.01) in DES group and stent length was longer in DES group (26.0짹6.12mm vs. 22.1짹5.5mm, p<0.001). In echocardiographic data, LV ejection fraction was lower in DES group (50.4짹16.4% vs. 53.1짹23.6%, p=0.008). Successful PCI was achieved in 97.4% of patients and showed no significant different between DES and BMS group (97.5% vs. 97.2%, p=0.419). Incidence of in-hospital death was significantly lower in DES group (5.3% vs. 8.5%, p=0.013). In survival analysis, DES was associated of lower incidence of total MCAE (HR=0.724, p=0.048), but no significant difference in incidence death/myocardial infarction (p=0.690) during one-year follow up. Conclusion: Deployment of drug eluting stent in management acute total occlusion of coronary artery was safe and associated with favorable long-term clinical outcome.