Cigarette smoking is a major modifiable risk factor for CVD. 313 patients with first episode of ACS (UA with ECG change, NSTEMI and STEMI) were prospectively studied to assess demographic profile, risk profile and angiography profile in smoker versus non–smoker. Subjects with age less than 40 years were more in the smoker than non–smoker subgroup(p<0.05). Smokers were predominately male (p<0.001).Smokers had a lower prevalence of hypertension compared with non–smokers (p<0.001).Smokers presented with more acute infarctions and less UA compared with non–smokers (P<0.001). Anterior wall STEMI was the most common presentation among smokers(P< 0.05). Single vessel disease was the most common CAG diagnosis in both smokers and non–smokers