The Ukrainian registry of acute coronary syndromes with ST segment elevation STIMUL enrolled 1103 patients and is the first registry research in Ukraine with two-year follow-up. After 24 months prospective data were collected by telephone contacts in 278 patients with ST-elevation myocardial infarction (MI). Our study aimed to examine the long-term prognosis of these patients and to compare their adherence to guidelines depending on the management of acute coronary syndromes with ST elevation. 19.38 % patients died between discharge and 24 month follow-up: 11,28 % after reperfusion and 22.76 % without interventions (Р<0,001). The risk of new non-fatal МI was substantially higher in patients without interventions – 27.65 % vs. 12.96 % in reperfused persons (Р<0.01). The rate of complications after primary angioplasty versus intravenous thrombolytic therapy did not substantially differ in patients after acute MI. The study showed relatively low usage of recommended guidelines treatment, especially due to social factors, and high rate of cessation of medications prescribed at discharge, especially among non-reperfused patients. In conclusion, non-adherence to medical treatment leads to more frequent development of recurrent myocardial infarction and death, especially among non-reperfused patients.