OBJECTIVES: Acute coronary syndrome (ACS) treatment guidelines recommend a range of interventions to prevent recurrence. The objective of this analysis was to assess patterns of resource use prior to and following hospitalisation for unstable angina (UA), ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). METHODS: Unique identifiers were used to link patients in a comprehensive hospital registry (Myocardial Ischaemia National Audit Project), with longitudinal primary care data (General Practice Research Database) and outcomes (Hospital Episode Statistics). The study population comprised patients ≥40 years, hospitalised for ACS from 2003-2009, discharged home. Resource utilisation was estimated at: 1) 1-2 year(s) prior to the hospitalisation; 2) one year prior to the hospitalisation to the hospitalisation itself; 3) discharge to one year after discharge; and 4) 1-2 years after discharge. Prescribed medications, consultations, laboratory tests and referrals to specialist care were assessed from GPRD. Hospital admissions and days spent in hospital, by cause, were assessed from HES. Analyses were repeated by discharge diagnosis and for patients prescribed clopidogrel in primary care within three months of discharge. RESULTS: Utilisation of all primary and secondary care resources assessed increased in the first three time periods, peaked in the year following discharge, and decreased in the second year. The average number of medications prescribed (mean (s.d.)) rose from (1)8.5(6.9) to  (2)9.6(7.3) to (3)14.2(6.7), followed by a decrease to (4)12.7(6.5). The average number of days spent in hospital rose from (1)2.7(11.1) to (2)4.5(12.8) to (3)8.5(20.3), followed by a decrease to (4)4.4(15.1). Resource utilisation was lower in patients with STEMI compared to UA and NSTEMI, but no difference in resource use was observed for patients treated with clopidogrel. CONCLUSIONS: Primary and secondary care resource utilisation increases prior to an ACS hospitalisation, with a peak in the year following discharge, and a slight decrease in the second year.