BACKGROUND: Patients with chronic kidney disease (CKD) are associated with poor outcomes after percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the prognosis in patients presenting with acute myocardial infarction (AMI) as compared with bare-metal stents (BMS). Thus we assessed differences in long-term outcomes after DES or BMS implantation in patients with CKD who presented with AMI . METHODS: Of 8291 patients with AMI who received PCI and were enrolled in Korean Acute Myocardial Infarction Registry, 24% of the patients had CKD (estimated creatinine clearance <60 ml/min). Of these, 165 patients (8.3%) received BMS and 1820 patients (91.7%) were implanted with DES (paclitaxel-eluting stent: 655 patients, sirolimus-eluting stent: 968 patients, zotarolimus eluting stent : 197 patients) between November 2005 and January 2008. Primary outcomes were defined as all-cause mortality and composite of major adverse cardiac events (MACE: cardiac death, nonfatal MI and repeat revascularization) at 1 year after PCI. . RESULTS: There were no differences in clinical characteristics. Patients with DES implantation had smaller stent diameter (3.0 vs 3.3 mm; P<0.001) and longer stent length (25.8 vs 22.2 mm; P<0.001) than those with BMS. Compared to BMS, DES implantation resulted in a lower 1-year rates of all cause mortality (11.8% vs. 21.2%, hazard ratio [HR] 0.543, 95% confidence interval [CI], 0.380 to 0.776, p=0.001), MACEs (13.3% vs. 19.4%; HR 0.665, 95% CI, 0.460 to 0.962, p=0.03), repeat revascularization (3.2% vs. 6.1%, HR 0.494, 95% CI, 0.252 to 0.966, p=0.039). However, there were no significant differences in clinical outcomes among three types of DES. CONCLUSION: In patients with CKD who present with AMI, DES implantation improves long-term prognosis as compared with BMS implantation.