OBJECTIVES: There is no enough data available in our country about the prevalence of risk factors for ST elevation myocardial infarction (STEMI) and which has the highest mortality rate in hospitals of Pakistan. The purpose of study was to access the age distribution, location of infarct, risk factors, sign & symptoms and in-hospital management of STEMI patients in Bahawalpur region, southern Punjab, on of the regions with high risk of coronary heart disease. METHODS: A retrospective study of 400 patients diagnosed as STEMI admitted to Bahawal Victoria Hospital (BVH), Bahawalpur, Southern Punjab, Pakistan was done by following their hospital record.  RESULTS: The mean age of STEMI patients were 40 ±10. Smoking, Diabetes and Hypertension were the risk factors (51.5%), (28%), (20.5%) respectively. Anterior wall Myocardial infarctions were seen (51.5%). Sweating, vomiting, shortness of breath (SOB) & nausea accounted for more than 60% of the symptoms with chest pain mostly in left arm. Among the patients who reached early to hospital & received Streptokinase (SK) were 150 (75%), those late for SK were 44(22%), thrombolytic therapy was contraindicated only in 6 (3%) patients. Most prescribed medication are aspirin (100%), clopidogrel (98%), statin (96%), ACE-I (77.5%), nitrates (69.5%), beta blocker (60%), anticoagulant (50%), LMW-heparin (33 %).  CONCLUSIONS: The result of our study, in which the risk factors especially smoking were found to have a prevalence in patients with STEM1 living in southern Punjab, suggested that STEM 1 can be prevented by the modification of these risk factors.