Introduction: Acute coronary syndrome (ACS) is a common and serious condition in developed countries. Cardiac rehabilitation (CR), by improving patient outcomes, is a recommended therapy for secondary prevention. However, less than one-third of eligible patients participate in CR programs in France. The objective of this prospective study was to identify the role of CR in the management of ACS and the barriers to its prescription in a cardiology center. Methods: All patients treated for ACS at the center between June 1 and October 31, 2014, were included. For each surviving patient, after discharge from the center, a questionnaire on CR was provided to the attending physician. Results: A total of 456 patients were included (80% men, mean age 65 years, 254 ACS cases with ST-segment elevation). Among them, 202 (48.2% of survivors) were referred for CR; 44 of them (21.8%) never started the program. Barriers to prescribing CR across the entire cohort were identified as: advanced age and/or significant comorbidities (46%), patient refusal (19%), lack of CR services near the patient’s home (19%), or unjustified failure to prescribe (16%). Age ≥75 years (RR: 0.29, p<0.01) and a history of coronary artery disease (RR: 0.34, p<0.01) are independent factors hindering CR prescription; female gender (RR: 0.61, p=0.09) and an LVEF of 45% (RR: 0.62, p=0.08) also tend to be limiting factors. Conclusion: In this study, the barriers to prescribing cardiac rehabilitation are numerous and primarily related to the patient themselves (limiting comorbidities or refusal).