Introduction - Available data comparing the long-term prognosis of different types of acute coronary syndrome (ACS) are limited and outdated. The objective of our study was to compare short- and long-term survival outcomes in ACS with and without ST-segment elevation (ST-elevation ACS and non-ST-elevation ACS) using data from the contemporary population-based MONICA registry (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease). Methods - Subjects aged 35 to 74 years who presented with a first episode of ACS during 2006 and resided in one of the three areas of France covered by the MONICA registry were included (the departments of Bas-Rhin, Haute-Garonne, and the Lille Urban Community). Data on clinical presentation, management, and short-term (28 days) and long-term (10 years) survival status, according to the type of ACS (ST-elevation ACS and non-ST-elevation ACS), were collected. Results - A total of 1,822 patients presenting with a first-time ACS, 1,121 (61.5%) ST-ACS and 701 (38.5%) non-ST-ACS, were included over a 1-year period. At 28 days of follow-up, mortality rates were 6.7% and 4.7% (p=0.09), respectively, for ST- and non-ST- ACS. After adjusting for potential confounding factors, the probability of death at 28 days was significantly lower for non-ST- ACS (OR=0.58, 95% CI: [0.36–0.94], p=0.03). At 10 years of follow-up, mortality rates were 19.6% and 22.8% (p=0.11), respectively, for ST- and non-ST- ACS. After adjusting for potential confounding factors, the probability of death at 10 years was not significantly different between ST- and non-ST- ACS (HR=1.07, 95% CI: [0.83–1.38], p=0.59). During the first year of follow-up, the overall mortality rate in the population was 7.2%, then decreased and stabilized at 1.7% per year from the 2nd to the 10th year following the initial ACS. Conclusion - ST+ ACS has a worse 28-day prognosis than non-ST+ ACS. However, at 10 years of follow-up, ST+ ACS and non-ST+ ACS have an identical prognosis.