The effective use of drug-eluting stents (DES) in the treatment of ST-elevation myocardial infarction (STEMI), a condition representative of acute coronary syndrome, has not been clarified, particularly among Japanese patients. The indication of DES for STEMI patients is discussed by reviewing the evidence from both Western countries and Japan. Currently, in the registry studies, randomized studies, and meta-analyses comparing the use of DES and bare-metal stents (BMS) in STEMI patients, DES show a consistent trend toward decreasing the risk of repeat revascularization without increasing the incidence of death, recurrent MI or stent thrombosis when compared with BMS in the treatment for patients with STEMI. Japanese data are also consistent with this trend. However, there are no clear data indicating safety concerns. Longer-term follow-up studies are necessary to assess the effectiveness of DES in STEMI patients. (Circ J 2010; 74: 2225-2231)