Introduction: It is unknown whether drug-eluting stents (DES), in comparison with bare metal stents (BMS), improve clinical outcomes of ST elevation myocardial infarction (STEMI) patients with renal insufficiency (RI). We aimed to compare the one year clinical outcomes of BMS versus DES, as well as sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES), in STEMI patients with RI. Methods: We included 874 consecutive significant RI patients (estimated glomerular filtration rate < 60ml/min) comprising 116 patients with BMS and 758 patients treated with DES (430 SES and 328 PES) from the Korea Acute Myocardial Infarction Registry (KAMIR). One-year target lesion revascularization (TLR), Myocardial infarction (MI), and cardiac death were ascertained. In addition to multivariate adjusted analysis, propensity analysis for stent choice was performed. Results: The composite outcomes, TLR, and cardiac deaths in BMS group were higher than those in DES group (HR [95% CI] = 2.3 [1.3-3.8], 3.7 [1.6-8.8], and 1.9 [1.0-3.8]), while among PS-matched populations the only composite outcomes were higher (HR [95% CI] = 2.0 [1.0-3.8]). In comparison between SES and PES, only composite outcomes were lower in SES group (HR [95% CI] = 0.6 [0.4-0.9] among total populations. However, there was no significant difference among PS-matched populations. Conclusions: In STEMI patients with RI, DES implantation for de novo coronary lesion exhibits a favorable one year clinical outcomes than BMS implantation.