Background: Renal insufficiency has been known to increase adverse outcomes including mortality and restenosis after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). There are limited data about the comparison between drug-eluting stents (DES) and bare-metal stent (BMS) in patients with renal insufficiency accompanied with left ventricular systolic dysfunction developed after AMI. Methods: We analyzed 887 eligible AMI patients with renal insufficiency accompanied with ischemic myopathy (ICMP) who survived at discharge from Korean Acute Myocardial Infarction Registry (KAMIR). Renal insufficiency was defined as GFR<60mL/min/1.73m2 to calculated by the Modification of Diet in Renal Disease(MDRD) study equation and ICMP was defined as LV ejection fraction <50% by biplane method after index event of AMI . They were divided to the 2 groups according to stent type (BMS group; n=73, DES group; n=814). The primary end point was the composite of 1-year major adverse cardiac events including death, recurrent myocardial infarction (MI), target vessel revascularization and coronary artery bypass grafting. Results: DES group was likely to have higher prevalence of smoking, female, and implanted more in left anterior descending artery than BMS group. Clinical presentation and the laboratory finding were similar between the 2 groups except Creatine kinase level was higher in DES group (2123.75 vs. 1519, p<0.039). In-hospital mortality were also comparable bwtween the 2 groups. DES reduced the risk of the composite the primary end point (48.1% vs. 20.0%, p<0.001), cardiac death (17.3% vs. 5.8%, p=0.002) and non-cardiac death (15.4% vs. 3.2%, p<0.001). However, there were no differences in the risk of recurrent MI, repeated PCI, target vessel revascularization (TVR) and coronary artery bypass grafting. Conclusions: In patients with renal insufficiency accompanied with ICMP, DES implantation had beneficial effects in the risk reduction of 1 year MACE, mainly due to the risk reduction of cardiac and non-cardiac death.