BACKGROUND: Mitral annular calcification (MAC) one of the most common echocardiographic abnormalities. MAC is associated with atherosclerotic risk factors such as advanced age, diabetes mellitus, hypercholesterolemia, hypertension, female sex, and chronic kidney disease. SYNTAX score (SS) is the angiographic scoring system and is commonly used to evaluate the severity and complexity of coronary artery disease. This study was conducted with the aim to evaluate the association between MAC and SS. METHODS: The medical records of consecutive patients, who underwent coronary artery bypass graft surgery, were retrospectively reviewed. The study group consisted of 312 patients. Taking into consideration the inclusion criteria, 68 patients with MAC and 244 patients without MAC (control group) were included in the study. Biochemical, clinical, echocardiographic parameters, and SS were evaluated in all patients. SYNTAX score was divided into two groups: >= 23: high, <23 low. RESULTS: Patients with MAC had higher prevalence of advanced age, hypertension, hyperlipidemia, female gender, and increased SS. On univariate analysis, advanced age, Hi HL, DM. current smoking. and MAC were associated with higher SS. On multivariate analysis DM, current smoking, and MAC were independent predictors for higher SS (OR 2.186; 95% CI: 1.863-4.094; P<0.001, OR 1.694; 95% CI: 1.218-2.493; P<0.001, OR 1.763; 95% CI: 1.327-3.058; P < 0.001 respectively). CONCLUSIONS: In our study, we have founded that MAC was independent predictor for higher SS.