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What is known and objective: The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post‐percutaneous coronary intervention (PCI) medications, along with predictors of non‐adherence. Methods: We conducted a retrospective observational cohort study to assess the adherence to post‐PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non‐adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post‐discharge. Results and discussion: A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P2Y12 inhibitors, 48.1% for statins, 39.6% for beta‐blockers and 42.9% for angiotensin‐converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non‐adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1–3.3; p‐value = 0.017, aOR = 1.87, 95% CI 1.1–3.3; p‐value = 0.029, respectively), while having a regular follow‐up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non‐adherence (aOR = 0.01, 95% CI 0.004–0.04; p‐value < 0.001, aOR = 0.06, 95% CI 0.03–0.1; p‐value < 0.001, respectively). What is new and conclusion: The adherence rate to post‐PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow‐up reduced the likelihood of non‐adherence. [ABSTRACT FROM AUTHOR]