Background PCI is considered the corner stone in ACS management. Multiple parameters have been studied as predictors of periprocedural complications. ABI is a non-invasive, rapid and easily reproducible tool to diagnose PAD and predict its complications. This study aimed to test the ABI as a predictor of periprocedural complications. Methods: ABI was measured to 91 men and 9 women (mean age: 55.7 + 9.5 years) presenting with ACS and undergoing PCI. Patients were classified into two groups according to their Doppler data: - Group I: included 12 patients with low ABI (subclinical PVD). - Group II: included 88 patients with normal ABI. The two groups were compared regarding the clinical presentation, risk factors, electrocardiographic findings, echocardiographic assessment of global myocardial contractility, cardiac biomarkers, and coronary Syntax score and finally the incidence of periprocedural complications. Results: Four patients of group I with subclinical PVD had procedural complications during PCI, no patients developed hospital complications and only 1 patient had re-infarction during 30 day follow-up with p. value of 0.25, 1.000 and 0.321, respectively. On the contrary, other predictors such as cardiac Troponin, Syntax score and low EF proved to be significantly related to the incidence of complications with p value of 0.04, 0.029 and 0.000, respectively. Conclusion ABI is of no value for prediction of adverse cardiac events after PCI. However, Low EF, Elevated Troponin level prior to PCI and high Syntax score are predictors of in-hospital and 30 day MACE and mortality.