Background: High-probability zones of coronary thrombosis may exist along the coronary tree. We aimed to determine the nature and distribution of significant coronary lesions among our patients. Methods: This study included 529 patients, for whom coronary angiography was done for ‎suspected or proved coronary artery disease (CAD), they were divided into three groups according to the distribution of the coronary lesions: left ‎anterior descending (LAD) group (n = 305) with significant LAD lesion, left circumflex (LCx) group (n = 148) with significant LCx lesion and ‎right coronary artery (RCA) group (n = 181) with significant RCA lesion. Results: One hundred and sixty-nine (31.9%) had nonsignificant lesion, ‎‎166 (31.4%) had single-vessel disease, with significantly higher incidence of significant LAD lesion 305 (57.5%) which were proximal 52.4%, ‎LAD lesions were more prone to be the culprit vessel 47.5%, LCx was the least vessel with significant lesion 148 (27.9%), and the least to be prone ‎as a culprit 21.1%. Proximal culprit LAD 63.5% and RCA 55.6% had significantly higher incidence, mid culprit LC× 53.9% had significantly ‎higher incidence. ST-elevation acute coronary syndrome (STE-ACS) was significantly more prevalent in culprit LAD 76.7%. Non-STE-ACS ‎was significantly more prevalent in culprit LC× 56.5% and RCA 55.6%. Conclusion: LAD tends to carry more than one culprit lesion, more to be ‎proximal. Risk factors responsible for instability and sheer stress (uncontrolled diabetes mellitus, uncontrolled hypertension, heavy smoking) were ‎more prevalent between patients with LCx as a culprit followed by RCA in Egyptian; this may throw the light on the need for aggressive control of these risk factors to reduce vulnerability in these patients.‎