Understanding the Status of the Egyptian Coronary Lesions: Lesion Location and Vulnerability El-Dosouky, Ibtesam Ibrahim; Nashy, Baher Nabil; Abomandour, Hala Gouda JOURNAL OF INDIAN COLLEGE OF CARDIOLOGY. 12(2):49-54, Apr-Jun 2022. 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.