Globally, metabolic syndrome presents as one of the leading health problems associated with increased morbidity and mortality from cardiovascular disease. Studies suggest that little is known about the prevalence of metabolic syndrome in patients with acute coronary syndrome in Indian subcontinent. Hence, our study aimed to ascertain the prevalence of metabolic syndrome and its clinical and angiographic profile in patients with acute coronary syndrome in Northwest Indian population.An observational study was conducted in the cardiology department of Pacific Medical College & Hospital, Rajasthan among 100 patients diagnosed with acute coronary syndrome for duration of one and half year. Demographic, clinical data, serum lipid profile, serum glucose was measured. Analysis was done using SPSS-23. The data were expressed as rates, ratios, proportions and mean ± standard deviation. The comparison of data was performed using Chi-square test/ Fisher's exact test, independent sample t-test. p<0.05 was considered statistically significant.The prevalence of metabolic syndrome in acute coronary syndrome was found to be 65%. Among the components of metabolic syndrome, waist circumference >90 cm for males, fasting blood sugar, previously diagnosed cases of diabetes mellitus, hypertriglyceridemia, low HDL cholesterol were significantly higher in MS group. Raised fasting Blood Sugar and systemic hypertension resulted in higher mortality.In the present study, metabolic syndrome was highly prevalent in acute coronary syndrome patients, with male predominance. Anthropometric measurements like waist circumference, waist-hip ratio, and BMI, which are easy clinical tools to identify obesity, should be routinely used in clinical practice.