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Troponin-positive acute coronary syndromes (Tn+ ACS) with angiographically healthy coronaries represent a rare entity that poses several etiological, prognostic, and therapeutic problems, as well as the problem of prevention of ACS in a non-atheromatous setting. The aim of this study was to investigate the epidemiological, clinical, and etiological features as well as the prognostic factors and therapeutic modalities of acute coronary syndromes with positive troponins and angiographically healthy coronaries. This was a retrospective descriptive study of patients hospitalized in the cardiology department at Habib Thameur Hospital between January 2004 and July 2011 for Tn+ ACS and healthy coronaries. In these patients we collected clinical and para-clinical data and the short and long term evolution. The prevalence of Tn+ ACS and angiographically healthy coronaries was 3.78%. The mean age of the patients was 50±14 years without gender predominance.