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Background: Acute coronary syndrome (ACS), is ischemic heart disease of varying risk factors and clinical pattern and with immense health burden worldwide. Inflammation is believed to be an etiological factor in ACS, and neutrophil to lymphocyte ratio (NLR), to be a biomarker.  Objectives: To describe the clinical pattern and risk factors of ACS in Afro-Arabs of Sudan and to evaluate the NLR as a severity marker.  Method: In a total population, cross-sectional study, conducted in Al-Shaab Hospital- Sudan, clinical, laboratory and ECG data were used for ACS grouping into unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI. All patients underwent coronary angiography (CAG) and their Gensini score and NLR were calculated.  Results: A total of 130 patients (62.3% men) of a median age of 58.0, 50.0-65.0 yrs., (range 32.0-82.0), were diagnosed with ACS; 44.6% STEMI, 37.7% NSTEMI and 17.7% UA. The median Gensini score was higher in STEMI (42.5, 12.0-71.0) and NSTEMI (40.0, 15.8-60.5) compared with UA (10.0, 5.0-23.0), p 0.002, similarly, was the NLR; 3.5, 1.6-4.6; 2.9, 1.5-3.8 and 0.9, 0.8-1.1, respectively p&lt;0.001. Furthermore, the NLR in concordance with CAG findings p&lt;0.001. Finally, hypertension, diabetes mellitus and dyslipidemia, respectively, were stronger ACS risk factors in women than in men unlike smoking, and family history imposed the least risk.   Conclusion: While the ACS clinical pattern was in-line with literature, the risk factors order was different, and it was different between sexes. Importantly, the NLR strongly associated with ACS severity, but failed to distinguish between NSTEMI and STEMI.

Disparity of risk factors and concordance of NLR with Gensini score in acute coronary syndrome in an Afro-Arab multiethnic nation