AIM: To evaluate the achievement of metabolic risk factor targets and influencing factors in ACS patients with diabetes during the 12 months after discharge. METHODS: We retrospectively analyzed data from the Chinese Cardiovascular Association database-iHeart Project. Patients who were hospitalized with a diagnosis of ACS between 2014 and 2021 and who had at least one measurement record of LDL-C, BP, or HbA RESULTS: Diabetes was identified in 1,027 (27.5%) of the eligible patients. The proportions of patients with diabetes achieving targets of LDL-C, BP, and HbA CONCLUSIONS: The achievement of multifactorial targets among patients with ACS is suboptimal, particularly among patients with concomitant diabetes. The optimal measurement strategy post-discharge is essential for improving the comprehensive management of metabolic risk factors in ACS patients.