Objective：To quantitative assess the effect of lipoprotein associated phospholipase A2（Lp-PLA2） level in predicting the severity of coronary lesions. Methods：A total of 123 patients who underwent coronary angiography and Lp-PLA2 detection were enrolled to evaluate Lp-PLA2 level in predicting acute coronary syndrome（ACS），multi-vessel lesions and SYNTAX Ⅱ score. Results：Lp-PLA2 was correlated with the diagnosis of coronary artery disease，multi-vessel lesions and SYNTAX Ⅱ score（all P < 0.05）. Lp-PLA2 had high sensitivity in predicting ACS（90.9%）and multi-vessel lesions（80.0%），high specificity in predicting SYNTAX Ⅱ score ≥23（81.7%）and ≥33（87.4%）. Lp-PLA2 was an independent risk factor for multi-vessel lesions and SYNTAX Ⅱ score ≥23 and ≥33（OR=1.004，1.003 and 1.004，respectively，all P < 0.05）. Subgroup analysis showed that the higher concentration of Lp-PLA2 predicted the higher risk of multi-vessel lesions in hypertension（OR=2.800，P < 0.05）and higher risk of SYNTAX Ⅱ score ≥23 in hypertension and diabetes patients（OR=3.586 and 18.000，respectively，both P < 0.05）. Conclusion：Lp-PLA2 can effectively predict the severity of coronary lesions，especially the sensitivity of ACS diagnosis and multi-vessel lesions and the specificity of SYNTAX Ⅱ score ≥23 and ≥33. The predictive value of Lp-PLA2 for coronary lesions is greater in hypertension and diabetes patients.