Background: An aneurysmal aberration of the artery known as coronary artery ectasia (CAE) is identified by significant dilatation and a luminal diameter that is 1.5 times larger than the surrounding normal segments. As opposed to coronary artery aneurysms, which only have a little extension of the arterial wall, it is different. Managing acute coronary syndromes (ACS) in isolated CAE can be difficult because there is no proven therapy and little research in this area. Objective: To determine the predictors of ACS occurrence among patients with coronary ectasia especially ectatic segment characteristics. Patients and Methods: The present study included 272 patients with coronary ectasia and classified as follows: Group (A): presented with ACS (n=112, 41.2%) and group (B): presented with chronic coronary syndrome (CCS) (n=160, 58.8%). Age or gender had no statistically significant impact on the development of ACS in the patients under study. Results: The best cutoff of serum D-dimer level in diagnosis of ACS was ≥ 0.85 and those of serum uric acid level, LDL cholesterol, CRP and serum triglycerides were ≥7.3 mg/dl., ≥178 mg/dl., ≥7.6 mg/l. and ≥181.5 mg/dl, respectively. There was statistically non-significant relation between ACS development and the culprit coronary, but notably ectasia was more frequently affecting the right coronary artery (RCA). The best cutoff of ectatic segment length in predicting ACS was ≥39 mm with area under curve 0.7, sensitivity 64%, and specificity 88%. The best cutoff of ectatic segment diameter in predicting ACS was ≥6 mm with area under curve 0.8, sensitivity 74%, and specificity 65%. Conclusions: With the aid of noninvasive conventional and laboratory risk factors, we are able to anticipate the development of ACS in patients with coronary ectasia and may then recommend the best course of action for preventing ACS recurrence.