Background: There is high prevalence of combined peripheral and coronary artery disease (CAD) related to atherosclerosis  with associated increase in morbidity and mortality . Objectives:The aim of our study was to find an association between ankle brachial index (ABI) and cardiac function in elderly patients with CAD using ejection fraction (EF). Method: A Case control study. The case group included 100 elderly patients who had peripheral artery disease ( PAD) divided into 2 groups according to age ( 60- 70 and > 70 years). The control group included 100 elderly subjects who didn't have PAD which were divided also into 2 groups according to age . Both groups have CAD and underwent coronary angiography (CA) showing significant CAD lesions. Echocardiography were done to all patients showing cardiac function. Results: EF was lowest in cases > 70 years (46.84 ± 9.82)and was highest in controls > 70 years (53.02 ± 5.53) which is statistically significant (P- Value 0.009). Also EF is correlated with ABI. Conclusion: There is a significant positive relationship between ABI and EF.