Background: Acute coronary syndrome (ACS) is a main reason of morbidity and mortality in patients with coronary heart disease (CHD) in developed nations. It’s one of three coronary artery diseases (CAS): ST-segment elevation myocardial infarction (STEMI), or unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI). The production of sensitive indicators of myocardial necrosis (for example, troponins) is considered a suggestive indication of myocardial cell necrosis and so meets the criteria of myocardial infarction. The goal of the registry is to assess patient features, practice pattern and outcome of ACS in this region using a registry design. Methods: This prospective and observational registry was carried out on 1000 Patients with ACS (whatever its type) in the period of six months in cardiac centres in the region of middle delta of Egypt. The survey took place in (Tanta, Mahalla, Mansoura, Shebin-Elkom, Damanhor, Kafr-Elsheikh, Banha and Cairo). Results: There was an insignificant difference in the primary etiology of ACS between both sexes. Women got less ACE inhibitors, mineralocorticoid receptor antagonists, beta-blockers, antiplatelets, statins, and nitrates, but received more digoxin, amiodarone, anticoagulants, and calcium channel blockers. There was an insignificant association in in-hospital and 1 year mortality between female and male, respectively. Conclusions: Smoking and hypertension are significant risk factors among patients raising an alarming sign for primary and secondary inhibition for CAD. The delay in seeking medical help is related to unawareness of the public on what to do raising important questions about EMS role and public health education.