Abstract Background: Coronary artery bifurcation lesion is one of the challenges in coronary arteries revascularization. Hemo-dynamic factors, as bifurcation angle is widely recognized for its involvement in atherosclerotic plaque formation. Aim of Work: Our aim of this study was to detect the effect of coronary artery bifurcation angle degree on the development of bifurcation atherosclerosis using Computed Tomography Coronary Angiography [CTCA] and its prognos-tic impact. Patients and Methods: The study was included 221 patients having low and intermediate pretest probability for Coronary Artery Disease [CAD]. Coronary arteries were investigated with CTCA for detection of bifurcation lesions, assessment of bifurcation angle and bifurcation lesion type, then 1 year follow-up period for Acute Coronary Syndrome (ACS). Results: 138 patients were males (62%) and 83 were females (38%). The meanage group was 55.7±9.8 years old. Bifurcation lesions were higher at LAD-LCx (125 patients, 56.5%) than at LAD-major diagonal (104 patients, 47%), than at LCx-OM (56 patients, 25%) (p-value <0.0001). At LAD-LCx sites there were higher bifurcation angles in patients with atherosclerotic bifurcation lesions than patients without bifurcation lesions (77.32º±18.1º vs. 62.24º±18.2º, p-value 0.001), while there was no statistically significant difference as regard bifurcation angels at LAD-diagonal and LCx-OM bifurcation sites. There was no relation between bifurcation angle and type of atherosclerotic plaque at the three studied bifurcation sites. Patients with wider bifurcation angels regardless lesions severity or management protocol had higher rates of ACS. Conclusion: A strong relation between LM bifurcation angel and the development of atherosclerotic lesions was noted, where wider bifurcation angles are more prone for atherosclerotic lesions, and more prone to develop ACS.