Aim. The aim of this study was to investigate the sexual satisfaction in patients with acute coronary syndrome.Background. Sexual relationship is a multidimensional phenomenon which is affected by many psychological, individual and social factors. Satisfaction of sexual relationship leads to the strength of the family.Method. In this descriptive-analytical cross-sectional study, 254 patients with acute coronary syndrome admitted to the coronary angiography ward in Shahid Beheshti hospital in Kashan, Iran, were recruited by convenience sampling in 2014. Data collection was done using the demographic and clinical data questionnaire and Larson's sexual satisfaction questionnaire. Data were analyzed in SPSS version 13 using descriptive and inferential statistics.Findings. The mean score of sexual satisfaction was 101.7±15.3. The mean score of sexual satisfaction for men and women were 104.53±9.8, and 98.94±18.9, respectively (P=0.04). The results of linear regression showed that the relationship between sexual satisfaction and gender by taking other confounding variables was statistically significant (P=0.026). A history of diabetes (p=0.048), smoking (p=0.001) and hypertension (p=0.001) were affecting this relationship.Conclusion. The level of sexual satisfaction in patients with acute coronary syndrome was high. The satisfaction in men were more than women. Also, a history of diabetes, hypertension and smoking in patients with acute coronary syndrome affected sexual satisfaction. Nurses should consider sexual needs of female patients with acute coronary syndrome, and also, that of acute coronary syndrome patient with a history of diabetes, hypertension and smoking.