Abstract Background: Coronary artery disease (CAD) is the most prevalent group of cardiovascular disorders. There is a well-es-tablished link between smoking and atherosclerosis. Aim of Study: To describe the coronary angiographic pat-tern of lesions among smokers compared with nonsmokers. Patients and Methods: This descriptive observational com-parative study involved 150 participants. Patients were divided into two groups, 75 participants in smoking group with history of cigarette smoking of one packet and more and 75 partici-pants in non-smoking group including patients who had never smoked cigarettes or abandoned smoking more than 5 years. Each patient included in our study was subjected to full histo-ry taking, thorough physical examination, standard laboratory investigations, electrocardiographic examination, transthoracic echocardiography (TTE) and invasive coronary arteriography. All coronary angiograms included anatomical description of lesions site. Results: The smokers group had 62.7% of the participants showing significant lesions, and a 37.3% with non-significant lesions. The non-smoking group had 42.7% of its participants with significant lesions compared and 57.3% with non-signifi-cant lesions. There was a significant difference between smok-ers and non-smokers patients regarding significance of coro-nary lesions. The diameter of stenosis between the two groups was compared, and was statistically different. Multivariate regression analysis determined the possible factors associated with CAD and increased affected arteries. We found that BMI, obesity, smoking, total cholesterol, LDL, EF, and FS were sig-nificant factors associated with CAD and number of affected arteries. Conclusions: The following factors are associated with CAD and increased number of affected arteries: BMI, morbid obesity, smoking, total cholesterol, LDL, EF, and FS. Clinical Implications: The clinical implication of our study stresses on risk factor modification with strong emphasis on quitting smoking, increasing physical activity and attempts at weight optimization in obese patients to reduce the burden of disease and early coronary intervention to manage these high-risk CAD patients Smoking cessation programs are neces-sary. Evidence shows risk reduction upon medical therapy and smoking cessation in atherosclerotic arterial diseases.