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Background: Soluble CD40 ligand (sCD40L) has been shown to have a significant role in pathogenesis of atherosclerosis development and plaque destabilization. The present study was done to investigate the association of sCD40L with angiographic severity of coronary artery disease in patients suffering from acute coronary syndrome (ACS). Methods: The study group comprised of 75 patients suffering from acute coronary syndrome. Blood sample was collected witnin 24 hours of admission prior to any intervention or angioplasty. Patients were divided into three groups of angiographic vessel score (AVS) according to coronary artery blockage - AVS1, AVS2, AVS3. Serum levels of sCD40L and CRP were measured using an ELISA and Troponin T was estimated by electro chemiluminiscence. Severity of coronary artery disease was evaluated using angiograpic vessel score (AVS). Results: Out of 75 study patients, 65 (87.5%) were males with mean age of 51.7 years. There was significant association between sCD40L levels and Angiographic vessel score (p=0.001) with sCD40L levels increasing with its severity [AVS-1, AVS-2 and AVS-3; 0.65 ng/dl (2.5), 0.20 ng/dl(2.66), 3.7 ng/dl(5.99)]. On the other hand, the median hs-CRP levels had no significant relationship with Angiographic vessel score (AVS-1, AVS-2 and AVS-3; 7.42 (5.3), 5.92 (5.9) and 7.19 (6.25) respectively) Conclusion: Serum sCD40L levels were found to be significantly associated with angiographic severity in patients suffering from acute coronary syndrome compared to hs-CRP levels. [ABSTRACT FROM AUTHOR]