Background The relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) remains largely unknown. This study aimed to explore the association of COPD with CAD, especially with multi-vessel disease (VD). Methods The data of 354 patients who underwent multi-detector computed tomography (MDCT) for suspected CAD were analyzed. Luminal narrowing was defined as at least one lesion 50% or greater stenosis. The analysis of serum biochemistry profile and spirometry were performed on all eligible patients, and the diagnosis of COPD was defined as the criteria of Global Initiative for Chronic Obstructive Lung Disease. Results Patients with CAD had a significantly higher complication of COPD than those without CAD (11.8% vs. 3.7%, P <0.001). Comparing with patients without COPD, those with CORD were more likely to have multi-VD, proportion of smoking and high C-reactive protein (CRP) (P <0.001). Multivariate Logistic regression analysis revealed that the multi-VD was significantly correlated with CORD (P=0.012) and CRP (P=0.015). Conclusions There was a high complication of COPD in patients with CAD, and CORD may be a critical risk factor for CAD, especially for multi-VD. CAD and CORD were closely associated and the interplay of systemic inflammation might in part explain the relationship between them.