OBJECTIVES: The current study primarily aimed to assess the current prescribing pattern of lipid-lowering agents and the percentage of LDL-C goal attainment in myocardial infarction (MI) patients in local practice, and to evaluate clinical outcomes of patients stratified by prescription of statins and by LDL-C level attained after discharge. METHODS: We retrospectively reviewed 696 hospitalized patients in the local ACS registry of Prince of Wales Hospital during 1 January 2008 to 31 December 2009 with data retrieved using computerized clinical records of all patients. RESULTS: Among the 402 MI patients included, 104 (25.9%) were not prescribed with statins at discharge. Percutaneous coronary intervention (PCI) performed or planned during hospitalization (OR: 0.324, p=0.001) and latest LDL-C level before discharge (OR: 0.221 for an increment of 1 mmol/L, p=0.009) were significant independent predictors of the absence of statin prescriptions at discharge. A significantly lower all-cause mortality rate (14.4% vs 51.7%, p<0.001), fewer total hospitalizations (p<0.001) and fewer hospitalizations due to cardiovascular problems (p<0.001) were observed in patients discharged with statins. LDL-C goal attainment of < 100 mg/dL (2.6 mmol/L) resulted in a significant reduction in mortality (10.8% vs 24.2%, p=0.001), but not for goal attainment of < 70 mg/dL (1.8 mmol/L). Significant difference in survival existed only when LDL-C cut-off values were above 92 mg/dL (2.4 mmol/L).  CONCLUSIONS: This study revealed a J-curve phenomenon in ACS patients of Hong Kong. Further research should be conducted to assess the necessity of aggressive LDL-C reduction to < 70 mg/dL (1.8 mmol/L).