Peripheral arterial disease (PAD) is a marker of increased risk of cardiovascular events and of poor prognosis in patients with coronary artery disease (CAD). The prevalence of unknown PAD amongst patients with ACS varies between studies according to the mode of diagnosis.To evaluate the prevalence of peripheral artery disease (PAD), diagnosed using the ankle-brachial index (ABI), in patients ACS with diabetic with or without tobacco user and to assess the profile of these patients; and to determine predictors of PAD.Prevalence of PAD in ACS was low in Bangladeshi population. Patients with PAD and ACS constitute a high risk group and require more attention. PAD with ACS especially STEMI is an independent predictor of in-hospital death.