Background: Microalbuminuria (MA) is a well- known risk factor for coronary artery disease (CAD) in diabetics and non diabetics. It is associated with higher cardiovascular mortality. However, the impact of MA on the morbidity and mortality of the acute coronary syndrome (ACS) in diabetic patients is not definitively known and the relationship between the degree of albuminuria and outcome of ACS is unclear. Aim of the Work: To Study the morbidity and mortality of diabetic patients presenting with acute coronary symptoms in relation to presence of MA during ICU admission. Patient and Methods: This study was planned to evaluate the impact of MA on outcome of ACS in diabetics patients admitted to ICU in internal medicine department Zagazig University. The study included 80 patients with acute coronary syndrome 60 diabetics and 20 non diabetics. Patients were classified into four groups: Group (A): 20 ACS non diabetic patients with no albuminuria. Group (B): 20 ACS type 2 diabetic patients without albuminuria. Group (C): 20 ACS type 2 diabetic patients with MA. Group (D): 20 ACS type 2 diabetic patients with macroalbuminuria. Urinary albumin excretion rate was performed to all patients with ACS. They were followed up during their staying in the ICU for the occurrence of heart failure, pulmonary embolism, shock, arrithymia or death. Serum lipid profile and HbA1c were performed also for all patients. Results: Complications occurred more significantly in albuminuric patients with MA (70%) and with macroalbuminuria (65%) than non albuminuric patients (20%);(P<0.001). Complications also occurred more significantly in patients with HbA1c>7%(69.7%) than those with HbA1c<7%(30.3%);(P<0.001). Also complications occurred more significantly in patients with serum triglyceride>150 mg/dl(78.4%) than those with serum triglyceride<150 mg/dl(14%);(P<0.001) and LDL>100mg/dl(82.4) than those with LDL<100mg/dl(15.3%);(P<0.001). Conclusions: There is a significant prevalence of albuminuria in diabetic patients in comparison with non diabetic patients. Complications including life threatening disorder as arrhythmia, heart failure, shock and cardiac arrest occurred more significantly in diabetic albuminuric patients with ACS during admission to ICU. Complications occurred more significantly in patients with abnormal lipid profile especially patients with hypertriglyceridemia or LDL > 100mg/dl