Background: CAD is the largest contributor of cardiovascular diseases (CVDs) and mortality rate is due in prevalence to atherosclerosis. Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has a prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. Objective: To assess the relationship between C reactive protein/albumin ratio (CAR), severity of coronary atherosclerosis assessed by the syntax score (SS) in patients with stable coronary artery disease. Patients and Methods: This study was a prospective cohort study conducted on 100 patients divided into two equal groups according Syntax score. All patients underwent elective percutaneous coronary angiography, and have the following: hemoglobin levels, serum creatinine, serum cholesterol, serum albumin, C- reactive protein, resting 12-lead electrocardiography and Doppler – echocardiography. Results: C-reactive protein/albumin ratio was significantly higher in patients with intermediate-high SS group. In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with serum Cholesterol, HDL and LDL. Conclusion: C-reactive protein/albumin ratio was more tightly associated with the complexity and severity of CAD, and was found to be an independent predictor for intermediate-high SS group.