Backgrounds: In patients with acute myocardial infarction (MI), treatment with drug-eluting stent (DES) is associated with reduced long-term mortality and repeat revascularization rates compared to treatment with bare-metal stents (BMS). We hypothesized different clinical and angiographic parameters may predict long-term outcomes in patients with ST elevation MI (STEMI) who received optimal primary percutaneous coronary intervention (PCI) using DES in comparison with those who received thrombolytic therapy or BMS implantation. Methods and results: We analyzed consecutive 4,290 patients with STEMI who underwent optimal primary PCI using DES and were enrolled in Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. Median follow up period was 343 days (range 1-882) and the incidence of major adverse cardiac events (MACE: cardiac death, nonfatal MI and revascularization) was 8.4 %. In univariate analysis, the patients who experienced MACEs (n=360) are more often female, older, diabetes and non-smokers than those without MACE (n=3,930). Clinically they had higher Killip class, TIMI risk score and glucose level, and lower systolic, diastolic blood pressure (BP), ejection fraction, glomerular filtration rate and body mass index. Angiographically they more frequently had multi-vessel disease, MI located at left main and low post-PCI TIMI flow. In Cox hazard regression analysis, systolic blood pressure (hazard ratio (HR) 0.988, 95 % confidence interval (CI) 0.981-0.995, P=0.001), stent diameter (HR 0.575, CI 0.342-0.968, P=0.037), diabetes (HR 1.499, CI 1.017-2.210, P=0.041) and N terminal pro BNP (HR 1.619, CI 1.101-2.380, P=0.014) are the predictors of 1-year MACE. Conclusions: Low systolic BP, high N terminal pro BNP, presence of diabetes and use of small DES at the time of PCI are the predictors of long-term outcomes in patients with STEMI who received optical primary PCI using DES.