Background and Aim: The correlation between clinical profile and angiographic severity in acute coronary syndrome (ACS) patients has been poorly documented. Hence, the present study aimed to study the clinical profile and correlate that with vessel burden, as witnessed by coronary angiography, in patients presenting to the hospital with ACS (ST-segment elevation myocardial infarction [STEMI]/non-ST-segment elevation [NSTE]-ACS) Materials and Methods: The study had enrolled 209 patients who had been diagnosed with ACS. All subjects were those who presented to the Emergency Medicine Department in a tertiary care center (south India). Coronary angiogram done for these patients by cardiologists was reviewed with a SYNTAX CALCULATOR (I AND II). Patient's baseline characteristics and clinical examination and interventional diagnosis details were obtained. Results: The clinical profile gathered from this geographical territory implied an increase in the angiographic severity of the coronary artery disease as measured by the SYNTAX score 1, with an increase in the duration of the said risk factor. Male gender was predominant and the major age group for ACS was 30 to 60 years. The most common presentation in ACS was STEMI. Diabetes and hypertension were the main risk factors for ACS. There was a striking occurrence of ACS among the young. Conclusion: STEMI was the major ACS presentation in this study population. The main risk factors noted were diabetes and hypertension. Besides smoking and alcohol abuse (in any study population), dyslipidemia was also a key risk factor observed. Mild left ventricular systolic dysfunction was predominant in this study. The SYNTAX score 1 increased with duration of observed and recorded risk factors.