Objective To explore and compare the pathological changes in the coronary arteries as well as the distribution of traditional Chinese medicine（TCM） pattens in coronary heart disease（CHD） patients with or without microalbuminuria. Methods Ninety CHD patients with microalbuminuria were included in the observation group

while 78 patients with only CHD were included in control group. The TCM pattens of all the patients were collected and classified into eight types

including heart blood stasis obstruction patten

qi stagnation and blood stasis patten

phlegm obstructing heart vessel patten

qi deficiency and blood stasis patten

yin and cold coagulation and stagnation patten

heart-kidney yin deficiency patten

both qi and yin deficiency patten

and yang decline and qi deficiency patten. Coronary angiography was used to measure the number of the coronary lesions. Gensini score was used to quantitatively assess and grade the degree of the coronary artery stenosis. Logistic regression analysis was performed to calculate the correlation between TCM pattens and pathological changes in coronary arteries. Results In the observation group

double-vessel and multiple-vessel stenosis were most commonly seen of the coronary lesions

and the degree of stenosis was mainly grade Ⅳ. The most frequent TCM pattens were heart blood stasis obstruction patten

qi stagnation and blood stasis patten

qi deficiency and blood stasis patten

and phlegm obstructing heart vessel patten. In the control group

the stenosis was mainly involved with single and double vessels

and degree of stenosis was mainly at grade Ⅲ. The TCM pattens were principally distributed in heart blood stasis obstruction patten

phlegm obstructing heart vessel patten

yang decline and qi deficiency patten

and qi deficiency and blood stasis patten. The comparison between groups were statistically significant（P<0.01）. The Gensini score of the observation group was significantly higher than that of control group（P<0.01）; the results kept consistency in favor of the observation group when analyzing patients with single TCM patten and combined pattens separately（P<0.01）. Logistic regression analysis showed that the pathological changes in coronary arteries were correlated with heart blood stasis obstruction patten

qi stagnation and blood stasis patten

phlegm obstructing heart vessel patten

and qi deficiency and blood stasis patten in patients with CHD and microalbuminuria（P<0.01）. Conclusion Patients with only CHD are mainly manifested as heart blood stasis obstruction patten

phlegm obstructing heart vessel patten

and yang decline and qi deficiency patten

while CHD patients with microalbuminuria are mostly related with heart blood stasis obstruction patten

qi stagnation and blood stasis patten

phlegm obstructing heart vessel patten

and qi deficiency and blood stasis patten. And the pathological changes in coronary arteries are more severe in CHD patients with microalbuminuria than without microalbuminuria.