OBJECTIVES: To assess the prevalence and determinants of pharmacotherapy in patients with myocardial infarction. METHODS: The Medical Expenditure Panel Survey (MEPS) data from 2004 to 2008 were used to conduct a retrospective cross-sectional study. Study sample included adults ≥ 18 years with myocardial infarction. Pharmacotherapy was defined as the use of aspirin, beta-blockers, statins or ACEI/ARB.  Descriptive characteristics were used to describe the study sample and utilization patterns. The predictors of pharmacotherapy use were modeled based on the Andersen Behavior Model using logistic regression. The year variable and the Charlson’s comorbidity index score (CCI) was also included in the analyses. A p-value of 0.05 was considered to be statistically significant. RESULTS: According to the MEPS, 55% of the patients received ACEI/ARBs, 68% received beta-blockers, 64% received statins and 75% received aspirin. Individuals who had a usual source of healthcare were twice as more likely to receive ACEI/ARBs (OR: 2.15; CI: 1.20 – 3.84). Also, patients who were publicly insured (OR: 0.50; CI: 0.28 – 0.90), those who resided in metropolitan region (OR: 0.69; CI: 0.50 – 0.95) and patients having a CCI score of 2, 3 or 4 were less likely to receive ACEI/ARBs. Females (OR: 0.63; CI: 0.44 – 0.91), blacks (OR: 0.45; CI: 0.30 – 0.66) and individuals who had a CCI score of 10 (OR: 0.22; CI: 0.08 – 0.58) were less likely to receive beta-blockers. Also, as age increased, the likelihood of taking beta-blockers (OR: 1.22; CI: 1.11 – 1.34) and aspirin (OR: 1.24; CI: 1.11 – 1.39) increased. Patients who had a usual source of healthcare were 3 times as likely to receive statins (OR: 3.05; CI: 1.53 – 6.10). CONCLUSIONS: Analyses of national level data revealed suboptimal utilization of evidence-based pharmacotherapy for management of myocardial infarction. Concerted efforts are needed to optimize pharmacotherapy in patients with myocardial infarction.