Background: Drug-eluting stent (DES) limit in-stent restenosis (ISR) and target vessel revaculization, but the comparison of long term safety and efficacy with bare metal stent (BMS) in patients with acute myocardial infarction (AMI) is still controversial. Methods: We compared long-term clinical outcomes between BMS (n=807) and DES (n=1,449) in patients with AMI (n=2,256, 66.8짹11.6 years old, 1,672 males) who visited our hospital between January 2004 and July 2006. They were followed up at least 3 years (mean duration: 32.5짹20.1 months). Primary end point was mortality and the composite of major adverse cardiac events (MACE)s including all cause mortality, myocardial infarction, target-vessel revasculization (TLR) and coronary artery bypass graft (CABG). Results: Clinical characteristics of both groups were not different. Angiographically DES group involved more left anterior descending artery (31.8% vs 57.5%, p<0.001), and left main artery (1.4% vs. 2.7%, p=0.040). Stent diameter (3.3짹0.5 vs. 3.2짹0.3 mm, p<0.001) was larger in BMS group, but stent length (22.3짹6.0 vs. 26.4짹5.7 mm, p<0.001) was larger in DES group. Other angiographic findings were not different between groups. In-hospital mortality rate was higher in BMS group (5.5% vs. 1.7%, p<0.001). At 3-year, mortality rate was higher in BMS group (9.5% vs. 4.1%, p<0.001). At 3-year, TLR (16.7% vs. 7.6%, p<0.001), and the composite of MACEs (25.4% vs. 11.7%, p<0.001) were higher in BMS group. Implantation of BMS was the independent predictor of 3-year MACE (OR=1.47, 95%CI: 1.19-1.81, p<0.001) and 3-year TLR (OR=2.64, 95%CI: 1.98-3.51, p<0.001). Conclusions: DES is superior to reducing 3-year target vessel revaculization and improving 3-year clinical outcomes in patients with AMI.