OBJECTIVES: Assessment and comparison of baseline clinical characteristics, current trend of utilization of key evidence-based-medications (EBM) and interventional strategies for ACS patients presented with and without diabetes. METHODS: This observational cohort study was conducted at The Heart Care Clinic, Ahmedabad among patients presented with ACS. In this cross-sectional study, data base from the clinic was accessed to collect the data. This includes demographic information, vital signs, personal particulars and details of other risk factors for ACS such as diabetes, smoking and family history of coronary artery disease. Also information pertaining intervention procedure (medical management or percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass grafting [CABG]) and medications prescribed at discharge were collected. RESULTS: Among 370 ACS patients, about 30% patients were diabetic. Typically, percentage of hypertensive patients was significantly higher among diabetics compared to non-diabetics (59.29% vs. 38.91%, p=0.0004). The difference in proportion of patients on medical management among diabetic and non-diabetic patient population was found to be highly significant (47.79% vs. 39.30%, p=0.0002). Key medications (ACEIs/ARBs, BBs, statins, and aspirin) were prescribed in 98.2, 85.0%, 87.6%, and 95.6% diabetic (113); while 97.3%, 82.1%, 93.8%, and 96.5% non-diabetic (257) patients, respectively on discharge. CONCLUSIONS: Diabetes is highly prevalent among ACS patient population and the worse prognosis in ACS patients from India may be attributed to clustering of several cardiovascular risk factors at presentation. The diabetics are being managed more frequently with cardiovascular medications rather than revascularization therapy (PTCA or CABG) compared to non-diabetics. Utilization of evidence-based-medication for both diabetic and non-diabetic ACS is consistent with the guidelines and recommendations and is not differing among the diabetic and non-diabetic population; except for the lipid lowering therapy. This observational study might serve as a maneuver to the current practice and highlights awareness on the adherence to the recommendations from the guidelines.