Background: Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver and several cancers. Objectives: To assess the relationship between carotid plaque score by carotid ultrasonography and severity of coronary artery disease (CAD) by SYNTAX score in metabolic syndrome patients undergoing coronary angiography. Patients and Methods: A cross sectional case-control study included 100 persons divided into two groups: Group (1) included 50 patients with metabolic syndrome and group (2) that included 50 patients did not fulfill the criteria for metabolic syndrome. They were selected from those attending the Catheterization Unit of the Cardiology Department, Al-Azhar University Hospital, Assiut. Results: There was no statistically significant difference between the two groups regarding age and gender (P > 0.05). There were a highly statistically significant difference between the two groups regarding hypertension, diabetes mellitus and waist circumference (P < 0.0001). Regarding HDL level, there was a statistically significant difference (P- 0.030), while there was no statistically significant difference regarding triglycerides level (P- 0.159). There was highly statistically significant difference between the two groups regarding plaque score and SYNTAX score (P < 0.0001) with strong correlation (r=0.907). There was a moderate positive correlation between plaque score and number of risk factors for metabolic syndrome (r=0.5) with a very high statistically significant level (P < 0.0001). Conclusion: There was a moderate correlation between carotid artery plaque score and Syntax score in metabolic syndrome patients.