Abstract: AIM To study the medications for patients with acute coronary syndrome in Xiangyang City and provide evidence-based medical therapy for acute coronary syndrome patients. METHODS Patients with suspected acute myocardial infarction or unstable angina pectoris admitted to our hospital were included in the study. Data of medication adherence and reasons for nonadherence were collected using standardized questionnaires and Cox regression was used to examine the medication status and associated factors at 6 and 12 months after hospital discharge. RESULTS The percentage of medication adherence was high (98% for aspirin, 85% for β-blockers and 97.8% for statins) at the time of hospital discharge but the percentage decreased during follow-up. Seventy-two percent of the patients were on the four-drug combination therapy (antiplatelet, β-blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, and statin) at discharge and the percentage reduced to 52.9% 1 year after discharge. Using adjusted logistic regression analyses, medical insurance, dyslipidemia, hypertension, and administration of treatment at discharge and during follow-up were reported. In a substantial proportion of patients, medication was considered “not indicated” by the treating physician. High drug costs were also partially influencing factors for adherence to the combined drugs. CONCLUSION Standardized medication rate of patients with diagnosis of acute coronary syndrome patients discharged from the hospital 1 year was 52.9%. The influencing factors of compliance to medications are complications, indications and high costs.