Aim To evaluate the correlation between carotid-femoral pulse wave velocity(cfPWV) and the severity of coronary artery lesion(Gensini score) and the predictive value. Methods According to the results of coronary angiography and Gensini score, 232 cases were divided into three groups:control group, low score group and high score group. The basic information, laboratory indexes, ultrasound and imaging data were collected. The differences of general data were compared in each group. Linear regression model was used for multivariate analysis. The predictive value of cfPWV to more than 30 points of Gensini score was evaluated by using receiver operating characteristic curve(ROC). Results (1)There were significant differences in age, gender, hypertension history, hyperlipidemia history, total cholesterol, myocardial ischemia, cfPWV, carotid intima-media thickness(IMT), Gensini score between low score group and control group(P＜0.05). There were significant differences in smoking history, diabetes history, body mass index(BMI), systolic blood pressure(SBP), fasting blood glucose(FBG), triglyceride, low density lipoprotein cholesterol(LDLC), homocysteine(Hcy), ankle-brachial index(ABI), plaque index(PI) between high score group and control group(P＜0.05). There were significant differences in age, smoking history, drinking history, diabetes history, BMI, SBP, FBG, LDLC, Hcy, myocardial ischemia, cfPWV, ABI, IMT, PI, Gensini score between high score group and low score group(P＜0.05).(2)Linear regression model showed that cfPWV, IMT, BMI, ABI, Hcy and hypertension history were the independent factors affecting Gensini scores.(3)The area under the ROC curve drawn by cfPWV level was 0.834(95%CI:0.783-0.885, P＜0.001), and the optimal boundary value of cfPWV in predicting more than 30 points of Gensini score was 12.2 m/s(sensitivity was 87.8%, specificity was 72.7%). Conclusion The cfPWV is significantly correlated with the severity of coronary artery lesion, and it has a certain value in predicting the severity of coronary artery disease.