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BACKGROUND In multiethnic societies, it has frequently and repeatedly been shown that some minority groups have higher rates of traditional coronary artery disease (CAD) risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CAD when compared with the white population. In the last two decades, Italy is becoming a diverse society with more than five millions of inhabitants from minority ethnic groups: for this reason, we decided to investigate whether ethnic differences in our metropolitan area are similar compared with the experience of Western countries. METHODS AND RESULTS We performed a retrospective cohort study of 1285 patients with acute coronary syndromes (ACS) hospitalized at Intensive Cardiac Care Unit (ICCU), Heart Center of ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy between 2014 and the end of 2019. Six percent of these patients were South-Asian, North-African, and South-American. Despite the younger age of nonwhite patients, their comorbid conditions and traditional cardiovascular risk factors showed peculiar differences. We did not observe any difference in terms of the number of coronary arteries involved at the enrollment, patients candidate to coronary artery bypass graft and either intra-hospital or at follow-up mortality. Nevertheless, the rate of re-infarction at follow-up was significantly higher in the nonwhite group. CONCLUSION We believe that a better knowledge and understanding of epidemiological changes in Italian society could improve our clinical practice, in particular, in order to better customize treatments and therapies.