Bare-metal stent (BMS) use in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has been associated with higher rates of adverse cardiac events, including target lesion and target vessel revascularization. The purpose of the present study was to determine which clinical characteristics predict BMS use in patients with STEMI undergoing primary PCI. Data were prospectively collected from all patients who underwent primary PCI for STEMI between January 1, 2004 and December 31, 2007 at four New York State academic medical centers. Demographics, baseline medical history, procedural characteristics, and in-hospital outcomes were compared in patients receiving DESs versus BMSs. Of the 1394 patients studied, a total of 290 (20.8%) patients received a BMS while 1104 (79.2%) received a DES. Patients receiving a BMS were more likely to have higher rates of prior coronary artery bypass graft surgery, prior PCI, peripheral vascular disease, and diabetes mellitus, and were more likely to be Hispanic and uninsured. They were also more likely to present with stent thrombosis and worse left ventricular ejection fraction (LVEF). Patients receiving a BMS had significantly longer hospital length of stay and a trend toward higher all-cause in-hospital mortality. In multivariate analysis, independent predictors of BMS use included uninsured status (versus private insurance) (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.70-4.67), peripheral vascular disease (OR, 1.96; 95% CI, 1.08- 3.56), and LVEF (OR, 0.98; 95% CI, 0.97-0.99). In conclusion, in this analysis of a contemporary cohort of patients undergoing primary PCI, lack of health insurance, peripheral vascular disease, and worse LVEF were independently associated with higher rates of BMS implantation in patients with STEMI undergoing primary PCI.