Aim To study characteristics of coronary artery pathological changes in the aged coronary heart disease(CHD) patients with metabolic syndrome.Methods A total of 162 aged cases with coronary heart disease were divided into two groups according to the status of being combined with metabolic syndrome(MS groups,54 patients) or not(non-MS groups,108 patients).Coronary arteriongraphy(CAG) scoring and assay of cardiac function,waist circumference,blood pressure,fasting blood glucose(FBG),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDLC),low density lipoprotein cholesterol(LDLC) were performed in all subjects and the left ventricular rejection fraction(LVEF) was measured with echocardiography.Results The MS patients suffered more from multi-vessel lesions,diffuse lesions and completely obstructive lesions( p< 0.05),LVEF decreased in MS groups.Conclusion The MS patients with multiple cardiovascular-risk factors,often have multi-branch lesion and more severe lesions.To treat cardiovascular risk factors actively is very important to prevent the CHD and improve its prognosis.