Background: CAD is a CVD that is the main reason for mortality worldwide. CAD is an inflammatory atherosclerotic disorder characterised by stable or unstable angina, sudden cardiac death or MI. Objective: Measuring the relationship between fQRS complex and CAD severity in CA cases. Patients and Methods: This research was conducted on 120 cases that performed coronary catheterization and with developed CAD. All cases underwent clinical examination, and 12-lead ECG. CA was performed using Philips machine under local anesthesia using seldinger technique.  Results: Our findings revealed highly significant correlation between prevalence of fQRS and SYNTAX score. There was statistically significant increased Syntax score in patients Inf. Notched R when compared Syntax score of patients without spikes in Inf. Notched R, statistically significant increased Syntax score in cases with non-Inf. Notched R when compared Syntax score of patients without non-Inf. Notched R statistically significant increased Syntax score in patients with Inf. Notched S compared with patients without Inf. Notched S. There was highly significant difference between prevalence of fQRS on admission and after PCI. Conclusion: fQRS complex is a simply assessed, noninvasive ECG parameter that predict the occurrence of significant CAD and validation of fQRS as Surveillance tool for CAD.