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Aim: The aim is to evaluate Serum Magnesium as a prognostic marker in Acute Coronary Syndromes (ACS) and to compare with Coronary Prognostic Index (CPI). Methods: This case control study conducted in the intensive care unit (ICU) of AVBRH, Sawangi, Wardha taking 150 cases of ACS and 150 healthy age and sex matched controls. CPI was calculated in the cases of ACS and Serum Magnesium was calculated on admission for cases and controls and was compared between them. P value of <0.05 was taken as significant.Results: 6% of the cases gave history of myocardial infarction and 22% gave history of Angina and 34.6% gave history of smoking. Mean levels of serum Magnesium on admission (mg/dL) in cases was 1.82 ± 0.29 and among controls was 1.86 ± 0.23 with no significant difference between them. The prevalence of Hypomagnesemia was seen in 30% of cases and 19.33% of controls. Significant negative correlation was seen between serum Magnesium levels on admission with CPI with correlation coefficient of (r=-0.293, p<0.01).Mean ± SD of CPI in patients with hypomagnesemia was 10.42 ± 5.36 which was significantly higher as compared to patients without hypomagnesemia (7.3± 3.34). Conclusion: This study concluded that MI was more prevalent among the male population than the female population. Hypertension, smoking, alcohol and diabetes are the common independent risk factors for ACS. Serum Magnesium levels can be predictive of severity of outcome in cases of ACS and is correlated negatively with CPI.