Background: Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis.It is thought to be implicated in the pathogenesis of atherosclerosis and in atheroscleroticplaque neovascularization and thus promotes its infiltration by inflammatory cells which maytrigger plaque destabilization.Aim of the study: To investigate the level of VEGF in acute coronary syndrome patients andwhether this level is higher than in control group and to determine whether this level ispositively correlated with the severity of the disease and the short in-hospital prognosis or not.Patients and methods: 78 patients (53 males & 25 females) their age ranged between 35 &77 yrs with a mean age of 54.7+9 yrs were classified into: Group 1: 31 patients presented byunstable angina. Group 2: 26 patients presented by non ST segment elevation infarction.Patients were furtherly divided according to the prior statin use into: 1A: statin treatedpatients in group 1 (16 patients), 2A: statin treated patients in group 2 (13 patients), 1B: nonstatin treated patients in group 1(15 patients) and 2B: non statin treated patients in group 2 (13patients). Group 3: 21 patients with no previous history of cardiac disease presented for chestpain evaluation & their results revealed normal coronary angiogram. All patients weresubjected to 12-lead ECG, echocardiography, routine labs including cardiac biomarkers, Lipidprofile, measurement of the serum VEGF by quantitative enzyme linked immunosorbantassay. Coronary angiograms were scored visually into: a severity score (0–3) defined thenumber of vessels with a luminal stenosis ≥50%. The severity and extent of CAD was gradedusing a modified Gensini score.Results:This study showed that the serum VEGF level was significantly higher in patients presentedwith either unstable angina or NSTEMI & were not previously treated with statin incomparison to control patients (357.5+142.8 & 257.0+146.7 vs 74.6+53.3 pg/L respectively,P < 0.001). And that the previously statin treated patients either in unstable angina or inNSTEMI groups had lower serum level of VEGF than controls (60.9+53.3 & 43.2+47.5 vs74.6+53.3 pg/L respectively, P: 0.009). It also revealed that of the serum VEGF level did notdiffer between unstable angina patients and NSTEMI patients either in previously statintreated patients or in non previously statin treated patients (60.9+53.3 & 357.5+142.8 vs43.2+47.5 & 257.0+146.7, pg/L, P value: 0.914 & 0.065) respectively.When patients in both groups 1& 2 were stratified into 3 groups according to the serum levelof VEGF , although there was a trend toward increase of number of coronary vessels affectedin high VEGF level groups (1.92+0.76 vs 2.15+0.89 vs 2.21+1.03 in low, moderate and highVEGF groups respectively, there was no significant correlation between the serum level ofVEGF and the coronary artery disease severity that assessed angiographicaly using modifiedGensini score (9.16+4.81 vs 10.31+4.27 vs 9.79+5.02 in low, moderate and high VEGFgroups respectively, P value: NS).Recurrent ischemic attacks were significantly higher in patients with higher serum VEGFlevel compared with patients with low serum VEGF level (12.0 vs 38.5 vs 68.4% in patientswith low, moderate and high VEGF respectively, p value: <0.001). Regarding development ofheart failure, it occurred more in patients with higher serum VEGF level compared withpatients with low serum VEGF level (12.0 vs 15.4 vs 36.8% in patients with low, moderateand high VEGF respectively, p value: 0.052).However was no significant correlation betweenarrhythmias or development of cardiogenic shock and the serum level of VEGF.Conclusion: VEGF serum level is higher in non statin treated patients presenting with acutecoronary syndrome and it may predict an adverse in-hospital prognosis but it was nocorrelation between VEGF serum level and angiographically defined disease severity.