Objective  To analyze influencing factors of acute coronary syndrome（ACS）in maintenance hemodialysis patient.Methods  The clinical data of 175 patients who underwent maintenance hemodialysis in the blood purification center of Chengde central hospital and Luanping hospital of traditional Chinese medicine from March 2015 to April 2018 were retrospectively analyzed. According to the occurrence of ACS, they were divided into two groups: 57 patients with ACS (ACS group) and 118 patients without ACS (nonACS group). The gender, age, underlying diseases of renal failure, age of dialysis, systolic blood pressure, diastolic blood pressure, dehydration of patients one month before ACS, hemoglobin, C-reactive protein, parathyroid hormone, albumin, blood lipid, blood uric acid and pulmonary artery pressure at ACS were collected for comparative analysis. Multivariate logistic regression analysis was used to screen the risk factors for ACS.Results  The majority of men in ACS Group [38 cases (66.66%)], while the history of atrial fibrillation, systolic and diastolic blood pressure before dialysis, excess flow, red blood cell distribution width (RDW), blood potassium (K⁺)  were lower than those in non ACS group, and ALB was higher than those in non ACS group (all P<0.05). Systolic blood pressure ≥160 mmHg (OR=3.240, 95%CI: 1.255～5.367, P<0.05) and superflow ≥3 500 mL/ time (OR=2.797, 95%CI: 1.033～4.574, P<0.05) were the related influencing factors of ACS in patients with maintenance hemodialysis.Conclusions  Poor pre-dialysis blood pressure control (mean systolic pressure ≥160 mmHg) and excessive  (mean superflow ≥3 500 mL/ time) increase the risk of ACS in maintenance hemodialysis patients.