Abstract： Objective The purpose of this study was to determine coronary artery pathological changes in diabetic patients with acute coronary syndromes(ACS). Methods 38 patients with ACS and fasting plasma glucose ≥ 7.0 mmol/ L (DM group)were enrolled. In the same period 47 controls with ACS and normal FPG (NDM group) matched with DM group on sex ,age range (+2 yrs), smoke cigarette ,serum cardiac troponin ,hypertension and myocardial infarction history.The contrast analysis of tow groups was done by coronary angiographic findings. Results ①The levels of serum fibrinogen, blood glucose and serum lipid in DM group were markedly higher than in NDM group(P<0.05).② Compared with NDM group, DM group had more extensive coronary artery disease and was more likely to have triple vessel coronary artery disease (44.73%比19.19%,P<0.05). DM group patients with ACS were less likely to have single coronary artery pathological changes (23.40%比44.68%,P<0.05) compared with NDM group. Conclusions The coronary artery pathological changes in ACS diabetics are extensive. ACS of DM comes from multi-factors conjunction.