AIM: To assess the clinical features, identify risk factors; describe the management andrnoutcome of patients who present with ACS in EDs in Addis, Ababa, Ethiopia rnMETHODS: A multicentre prospective cross-sectional study was carried out fromrnSeptember 21, 2018 to July 1, 2019 among patients >18 years old presenting to the ED withrnACS. rnRESULTS: 40 patients were enrolled during the study period. Majority of them were malesrn(72.5%). The average age of patients affected is 58.03 + 11.831 years. The commonestrnpresentations were easy fatigability (92.5%) followed by chest pain and diaphoresis 77.5%.rnOf those who had chest pain, most (45%) expressed it as squeezing and severe in qualityrn(40%). 65% had radiation mostly to the arms(35%) followed by the shoulder(27.5%).Thernmean duration of illness prior to presentation to the ED of the study area was 4.41+2.83. Therncommonest risk factors identified were hypertension (60%) and type 2 DM (57.5%). STEMIrnwas the major type of MI identified (67.5%) with 30% in Killip class I. NSTEMI was seen inrn17.5% and Unstable angina in 15%. Heart failure was the commonest complication atrnpresentation. The commonest echocardiography finding was wall hypokinesis (67.5%)rnfollowed by decreased Ejection fraction (37.5%). Patients with STEMI had higher increase inrnthe cardiac markers than NSTEMI. None of the patients received thrombolytics/fibrinolytics.rnPCI was done for 42.5% with only 15% done as primary PCI. Most patients (70%) stayed inrnthe ED for more than 24 hours up to 7days. Death within 7 days of admission to the hospitalrnwhile in patient occurred in 10%. The live discharge rate was 90%. rnCONCLUSION: Patients present very late to the Emergency department; most of them withrnSTEMI with heart failure as the commonest complication upon presentation. They then stayrnin the emergency department for prolonged period of time in limited technical facilitiesrnwhich pose major difficulties of their management and subsequently poorer quality of life.