A 3-D or large-aperture 2-D synthetic transmit aperture (STA) ultrasound imaging system with a fully sampled array usually leads to high hardware complexity and cost since each element in the array is individually controlled. To reduce the hardware complexity, we propose a large-pitch method for STA (LPSTA) imaging integrated with a spatial response function (SRF) in the image reconstruction to improve image quality. To achieve this, we decreased the total number of measurement channels M (the product of the number of transmissions IT and the number of the receive channels in each transmission IR ). We combined L adjacent elements in transmission and K adjacent elements in receive into subapertures (SAPs), where L and K were coprime (no common factors) integers to suppress the grating lobes. We denoted it as an ( N/L, N /K ) system, where N is the number of transducer elements. In this article, first, we derived the beam pattern of the LPSTA using a far-field approximation. We demonstrated that the coprime selection and SRF can significantly reduce the grating lobes level (GLL) by using a beam pattern analysis. We also found that the LPSTA can have a similar beam pattern as that of a full array when the target is located along the steering direction. Second, the imaging performance of LPSTA was evaluated and validated with Field II simulations and experiments. The simulation results demonstrated that the proposed LPSTA with ( N /3, N /5) can achieve on average ~25% improvement in lateral resolution, ~24.6% and ~42.3% improvement in contrast-to-noise ratio (CNR) and contrast ratio (CR), respectively, over B-mode with a large-pitch receiver with ( N , N /5). LPSTA achieved comparable image contrast to the standard STA with the full array ( N , N ) at the cost of a reduced field of view. The experiment results were consistent with the simulation results. Finally, in addition to reducing the system (hardware) complexity, the LPSTA was more computationally efficient than the standard STA with a full array. The proposed method may help in realizing clinical applications of real-time 2-D or 3-D ultrasound imaging using large arrays.