Background: Visfatin is a novel adipocytokine which mainly found in visceral adipose tissue. Visfatin may be related to endothelial function, which is indispensable for coronary circulation, and may be an indicator of an inflammatory event in the coronary arteries. Objective: To evaluate the severity of Coronary Artery Disease in relation to serum visfatin level. Patients and Methods: This was a case-control study done at Bab El-Sharia University Hospital, Al-Azhar University, arranged to conduct 90 Egyptian patients underwent elective coronary angiography for suspected CAD. Patients were divided into 60 patients with CAD (patients group), and 30 patients with normal coronary angiography (control group).The severity of CAD was assessed using coronary angiography by estimating the number of vessels affected. Patients with CAD were divided equally to: diabetic patients with coronary artery disease and non-diabetic patients with coronary artery disease. Results: Visfatin was higher in patients group in comparison to control group; it was 16.68 ± 4.67 and 2.95 ± 0.87 respectively, and it was clear that the serum level of visfatin was significantly higher in groups with more vessels involvement. As the Mean ± SD of visfatin in one vessel group was 13.13 ± 2.77 and was 16.95 ± 2.89 and 21.99 ± 3.91 in two vessels and three vessels respectively. In comparison between diabetic and non-diabetic patients, visfatin was significantly higher in diabetic patients with coronary disease artery disease (Mean ± SD: 18.97 ± 4.54) than non-diabetic patients with coronary artery (Mean ± SD: 14.39 ± 3.59). Conclusion: Patients with CAD showed increased visfatin serum levels particularly diabetics. Moreover, high visfatin levels were significantly correlated with CAD severity.