Objectives: To determine the proportion of patients with metabolic syndrome using both International Diabetes Federation (IDF) and Asian Modified National Cholesterol Education Program - Third Adult Treatment Panel (NCEP - ATP III) criterias, and its associated factors among patients undergoing coronary angiogram in Hospital Universiti Sains Malaysia. Materials and Methodology: A cross-sectional study was conducted from September 2006 to April 2008 on 236 patients undergoing elective coronary angiogram in Hospital Universiti Sains Malaysia, Malaysia. Demographic, anthropometric, biochemical parameters and coronary angiography result were reviewed. Results: A total of 228 patients underwent coronary angiograms. The proportion of persons with metabolic syndrome using IDF and Asian modified NCEP ATP HI criteria were 50.0% and 76.8% respectively. There was a significant association between metabolic syndrome (Asian modified NCEP ATP III criteria) with age (OR = 2. 20, 95%CI: 1. 04, 4.68), female sex (OR = 3. 99, 95%CI: 1. 28, 12.3) and smoking (OR = 7. 0, 95%CI: 3.05,16.0). Conclusion: The proportion of metabolic syndrome patients was higher using Asian modified NCEP ATP HI vs. IDF criteria. Age more than 60 years old, female sex and smoking were significantly associated with metabolic syndrome.