This is a review of the literature comparing the efficacy and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with acute myocardial infarction (MI). The present article reviews whether DES are beneficial in the setting of primary percutaneous coronary intervention (PCI), and this has been the subject of many recent publications and debate among clinicians. To the best of our knowledge there are limited registries and randomized trials about DES for acute MI in the English literature. Bare-metal stents have a higher incidence of instent restenosis whereas DES might have a slightly higher late thrombosis risk. With the current data DES might still have an advantage over BMS in the treatment of ST-segment elevation MI (STEMI) patients with the vastly improved target vessel revascularization rates. Despite the lack of well-designed head-to-head long-term prospective clinical trials, DES may not be effective in patients who are on short-term dual antiplatelet therapy owing to an increased risk of late stent thrombosis. In conclusion, DES use in STEMI patients continuing long-term dual antiplatelet therapy is safe and effective.