Aim: The purpose of this study is to compare the clinical and angiographic patterns of coronary artery disease in smokers and users of smokeless tobacco. Material and methods: We looked at the patients' routine reports, such as their fasting and postprandial blood sugar levels, lipid profiles, renal function tests, and liver function tests. Final enrollment of research participants consisted of 200 patients out of a total of 400 patients. These patients had a history of tobacco smoking, either in the form of smokeless tobacco or smoked tobacco, but did not have any additional cardiovascular risk factors. CAD in patients is divided into many clinical patterns such as chronic stable angina, unstable angina, non-ST elevated myocardial infarction (NSTEMI), and ST elevated myocardial infarction (STEMI), based on the history, clinical, and laboratory findings (STEMI). Results: It was revealed that the prevalence of female users of smokeless tobacco, which was 18%, was considerably greater in comparison to the prevalence of female smokers, which was 6%, and the p value for this comparison was 0.0033. On the other hand, STEMI was the most prevalent pattern seen in smokers, occurring in 31% of patients. This was followed by NSTEMI, which occurred in 30% of patients, unstable angina, which occurred in 20% of patients, and chronic stable angina, which occurred in 19% of cases. Conclusion: As compared to smokers, those who use smokeless tobacco had a reduced prevalence of fatal coronary disease as well as multi-vessel disease. More than one third of people who use smokeless tobacco and present to the cardiac catheterization lab with angina or angina equivalent have fatal coronary artery disease, either in the form of STEMI or NSTEMI.