Abstract: Objective: To explore the disparity between the treatment of different types of acute coronary syndrome(ACS) in the basic secondary hospital and the guidelines. Methods: A retrospective analysis was performed on 119 ACS patients. Among them,64 suffered from ST-segment elevation myocardial infarction(STEMI) and 55 non-ST elevation myocardial infarction(NSTEMI) or unstable angina pectoris(UAP). Results: Among the 64 cases of STEMI,18 received urokinase thrombolytic therapy; 23 patients in the STEMI group (29.7%) and NSTEMI/UAP group(7.3%) were transferred to other hospitals to receive percutaneous coronary intervention(PCI) treatment (35.9%) when in stable condition. The difference was significant. Among the patients in STEMI group and NSTEMI/UAP group 98.4% and 98.2% were respectively administered Aspirin,92.2% and 67.3% clopidogrel,73.4% and 83.6% angiotensin converting enzyme inhibitors or angiotensinⅡreceptor antagonist,98.4% and 92.7% statins,60.9% and 78.2% β receptor blockers, 93.8% and 72.7% low molecular weight heparin(LMWH),82.8% and 94.5% nitrate drug,0.3% and 12.7% calcium channel blockers(CCB),and 82.8% and 90.9% Chinese medicine. The clopidogrel,LMWH and reperfusion therapy were more often used in the STEMI group than in the NSTEMI/UAP group (P < 0.01), while β-blocker and nitrate drugs were less used (P < 0.05). Conclusions: The guidelines are better implemented in management of STEMI than that of NSTEMI/UAP in basic secondary hospitals. There are still chances to improve.