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Objective: To determine the frequency of angiographically significant coronary artery disease (CAD) in patients undergoing valve replacement surgery and referred for Coronary angiography. Study Design: Cross Sectional Descriptive Study. Study Setting& duration: From 14th February 2016 to 14th August 2016 in the Department of Cardiology, Tabba Heart Institute, Karachi. Material and Methods: Total 127 patients of both genders with age 40-75 years undergone referred for coronary angiography and as a pre requisite of required valve replacement surgery were included and significant findings were noted. The history of comorbid, family history of premature CAD, smoking and basal metabolic index were noted. Results: There were 58.3% male and 41.7% female patients. Average age was 54.60±8.91 years. Mean BMI was 28.64±4.62 Kg/m2. 75.6% patients were obese. Angiographically significant CAD was observed positive in 27.6% patients. Significant association was found with hypertension and premature family history of CAD. The prevalence was high in patients with MVR followed in patients with AVR. Conclusion: The overall prevalence of angiographically significant coronary artery disease was 27.6%.in cases going through valve replacement is substantial. The prevalence was high in patients with MVR followed in patients with AVR. Keywords: CAD, Angiography, Significant Coronary Artery Disease, Valve Replacement Surgery