Background: Questions about the long-term safety over the beneficial effects of drug eluting stens (DES) have grown, especially in patients with acute myocardial infarction (AMI). Objectives: We compared the long-term safety and efficacy between DES and bare-metal stent (BMS) in patients with AMI. Methods: 1,017 AMI patients treated with stent implantation were followed for 3 years. 660 (64.9%) patients were treated with at least one DES and 357 (35.1%) patients were treated with at least one BMS. The primary end points were total mortality and the composite of major adverse cardiac events (MACE) including total mortality, re-MI, target lesion revascularization (TLR), and coronary artery bypass graft (CABG). Results: No difference was observed in baseline clinical and procedural characteristics. At 3-year, overall risk of cardiac and call-cause mortality were not different between the groups. But the use of DES significantly decreased TLR (17.4% vs. 7.1%, adjusted Hazard Ratio [HR] 0.44, 95% confidence interval [CI] 0.30 to .65) and the composite of MACEs (27.2% vs. 19.5%, adjusted HR 0.65, 95% CI 0.48 to 0.87) with no differences in MI. The risk of MACE up to 1 year (HR 0.56, 95% CI 0.39 to 0.80) was higher in BMS patients, but from 1 year to 2 years (HR 0.55, 95% CI 0.27 to 1.10) and from 2 years to 3 years (HR 1.13 95% CI 0.56 to 2.28), it was similar between the groups. Conclusion: The use of DES does not have a significant effect on overall long-term clinical survival compared with that of BMS in AMI patients. However, the use of DES reduced the need for re-intervention and the risk of MACE, mostly within 1 year.