Background: Effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) in large vessels remains controversial, particularly in patients with acute myocardial infarction (MI). Objective: This study compared clinical outcomes of DES versus BMS in large coronary arteries in patients with acute MI. Methods: A total of 985 patients who underwent single-vessel percutaneous coronary intervention (PCI) with a stent ���3.5 mm in diameter and <25 mm in length were divided into 2 groups (DES group: n=841 and BMS group: n=144). Clinical outcomes at 30 days, 6 and 12 months were compared. Propensity score analysis with logistic regression was used to control for confounders. Results: In-hospital outcome was similar between the groups. At six months, death/MI rate was not different. However, DES group had significantly lower rates of target-lesion revascularization (TLR) (1.7% vs. 5.6%, p=0.021), target-vessel revascularization (TVR) (2.2% vs. 5.6%, p=0.032), and total major adverse cardiac events (MACE) (3.4% vs. 11.9%, p=0.025). At 12 months, the rates of TLR and TVR remained lower in the DES group (2.5% vs. 5.9%, p=0.032 and 5.9 vs. 3.1%, p=0.041), but the rates of death/MI and total MACE were not statistically different. Conclusion: The use of DES in large vessels in the setting of acute MI was associated with lower need for repeat revascularization without increasing the overall safety during 1-year follow-up.