Background/Aims: The aim of the present work was to evaluate the association between exclusive olive oil consumption and the development of left ventricular systolic dysfunction (LVSD) in patients with a previous acute coronary syndrome (ACS). Methods: From 2006 to 2007, 651 consecutive ACS patients were enrolled. In 288 males (64 ± 13 years) and 75 females (71 ± 11 years), LVSD (ejection fraction <40%) developed after the cardiac event, and 221 males (62 ± 11 years) and 69 females (66 ± 11 years) were without LVSD (ejection fraction >50%). Detailed information regarding their clinical characteristics, anthropometric data, physical activity, smoking and dietary habits (including lipids use) were recorded. Results: 70% of the LVSD patients and 76% of the non-LVSD patients reported exclusive olive oil consumption. Multi-adjusted analysis revealed that exclusive olive oil consumption in post-ACS patients with a first cardiac episode was associated with a 65% (95% confidence interval 0.14–0.87) lower likelihood of developing LVSD after adjusting for various confounders. No significant association was observed among participants with a previous history of ACS. Conclusions: Exclusive, long-term olive oil consumption seems to offer significant protection against the development of LVSD in post-ACS patients.