Background: Diabetes mellitus (DM) is one of the most potent risk factors for coronary artery disease (CAD). Consequently, the diagnosis of CAD in diabetic patients is very important as early as possible. Microalbuminuria is a strong and independent indicator of increased cardiovascular risk among individuals with and without diabetes. Objective: This study aimed to assess the relation between microalbuminuria and the angiographic severity of CAD patients with type 2 DM by SYNTAX I, SYNTAX II and Gensini scores. Patients and Methods: A total of 82 patients with type II DM who were referred for elective coronary angiography owing to a suspected CAD were included in the study. Urinary albumin- creatinine ratio (UACR) was calculated for all patients, and the severity of CAD was assessed using the SYNTAX score, SYNTAX II score and Gensini score. Results: The study population comprised of 56 (68.3%) males and 26 (31.7%) females. Their mean age was 56.29±9.18 years. Patients were classified into two groups based on the level of UACR; group 1 included patients with UACR less than 30 mg/ g (41 patients), and group 2 included patients with UACR greater than or equal to 30 mg/g (41 patients). The study revealed significantly higher SYNTAX score in patients in group 2 compared with patients in group 1 (P=0.001) and significantly higher Gensini score in patients in group 2 compared with patients in group 1 (P=0.001). There was a positive correlation between age and the duration of DM and UACR (p=0.003), There was also a positive correlation between hypertension (HTN) and the duration of DM and UACR (p=0.049). Conclusion: Microalbuminuria can be used as a predictor of the presence and severity of CAD in type II DM.