Background: The risk of dyslipidemia, type 2 diabetes, and metabolic syndrome is increased by central obesity and rising BMI. When predicting the severity of coronary artery disease, waist circumference is a more reliable indicator than BMI. Therefore, our goal was to determine whether or not patients with central obesity satisfied the criteria for metabolic syndrome by predicting the severity of coronary artery disease as determined by coronary angiography (Syntax Score). Methods: This cross-sectional study included 100 obese patients' with symptoms of coronary artery disease (CAD) whose coronary angiography was performed. Each patient's waist circumference (WC) and body mass index (BMI) were determined independently. The SYNTAX Score was used to determine the severity and complexity of CAD. Results : Our study found that body mass index (BMI) correlates with high levels of fasting blood glucose(FBG), cholesterol, triglycerides, low density lipoproteins (LDL) and low levels of high density lipoproteins (HDL). Waist circumference (central obesity) correlates with triglycerides and Syntax Score (severity of CAD). Waist circumference that is ≥ 130 cm has highest sensitivity (85.71%) and specificity (82.56%) to detect high Syntax Score. Metabolic syndrome (Mets) is associated with high levels of FBG, cholesterol, triglycerides and low levels of HDL. Also, Mets is associated with high Syntax Score (severity of CAD). Conclusion: There is a statistically significant relation between syntax score grades and waist circumference.