Introduction:Acute Coronary Syndrome (ACS) is a leading cause of morbidity and mortality in Saudi Arabia (SA). This cross–sectional study assessed physicians’ knowledge, attitudes, and practice regarding ACS.

Methodology: The study was conducted on general and family physicians in primary health centers (PHC) in Dammam and Khobar in Saudi Arabia’s Eastern Province. Participants self–completed questionnaires. Descriptive statistics, associations, and predictors of practice were determined.

Results:Most physicians underwent electrocardiogram training (69.9%), 81.7% responded correctly regarding ACS diagnosis, and 58.8% regarding initial management. Two–thirds of physicians had positive attitudes. Higher numbers of ACS patients managed in PHCs, attending electrocardiogram training, and specialty were significantly associated with practice.

Conclusions: PHC physicians have better knowledge of diagnosis over initial management practices. Over two–thirds of physicians have a positive attitude. Previous experience is associated with a better knowledge score and positive attitude, which are predictors of practice.