Introduction - The objective was to compare the clinical management of patients presenting with first-time acute coronary syndrome (ACS) across the three French registries. Materials and Methods - During 2006, all cases of first-time ACS in patients aged 35–74 years were recorded (n = 1,908). The data collected included clinical, enzymatic, and electrocardiographic (ECG) characteristics, the entire course of care (treatments, invasive procedures, severity indicators), and vital status. Results - Among ACS patients with ST-segment elevation on ECG, emergency revascularization was performed more frequently in Strasbourg (70%) and Toulouse (71%) than in Lille (61%). Fibrinolysis was rarely used in Strasbourg (2%) but was used in 26% of cases in Lille and Toulouse. Regarding recommended treatments (antiplatelet agents, beta-blockers, ACE inhibitors, statins), prescriptions were similar across the three regions at the end of hospitalization and on the discharge prescription. Functional rehabilitation was prescribed 1.5 and 3 times less frequently in Toulouse and Lille, respectively, than in Strasbourg. Among ACS patients without ST-segment elevation, differences between registries were also observed. Across all ACS cases, women and older patients were less likely to undergo revascularization, and medication prescribing was less optimal. Conclusion—There are differences in the fundamental therapeutic management of ACS, which appear to stem in part from regional practices. (R.A)