This study was conducted to reflect the clinical profile of patients presented to Emergency department (ED) with complications of acute coronary syndrome in developing country like India. This prospective cohort study was conducted in a cohort of 50 patients' with acute coronary syndrome (ACS). They were followed up an over duration of three months for the outcome during hospitalization. Male; smoker; age > 60 years; hypertension were representative risk factors for this cohort. More than 96% of patients presented with chest pain, mostly in early morning hours. Thrombolysis was given to 46 patients (92%); and out of these, 21 (42%) patients succumbed to death. This study emphasised mainly on health education on adoption of health lifestyles and symptoms; early access to health care algorithm control of hypertension and related morbidities. The study has also tried to address need of policy ramification for strengthening for Non-communicable diseases in developing countries. ReseaRch study-PRosPective cohoRt Check for updates Methodology This prospective cohort study was conducted over duration of three months in one of the government medical college in India. Government medical college in India provide free medical care. Medical college