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Background: Previous studies have shown that beta 2-microglobulin (B2M) could predict all-cause mortality and cardiovascular mortality in various groups of people. However, the relationship between B2M and severity of coronary stenosis in patients with acute coronary syndrome has not been established., Methods: We enrolled 872 consecutive patients admitted with acute coronary syndrome in our study. All participants underwent coronary angiography examination or stent implantation after admission. The severity of coronary stenosis was assessed by Gensini score and the presentation of triple-vessel disease. B2M and other biochemical parameters were measured. All subjects were divided into quartiles of B2M. Multivariate linear regression and logistic regression were applied in the analysis., Results: Gensini score and the prevalence of triple-vessel disease were elevated in accordance with increasing B2M quartiles (p=0.002 and p<0.001, respectively). Multivariate regression showed diabetes (p=0.031), high-sensitivity C-reactive protein (hs-CRP, p=0.043) and B2M (p=0.006) were positively correlated with Gensini score. Logistic regression analysis revealed that the crude and fully adjusted odds ratios of triple-vessel disease were 2.34 (95% CI: 1.58-3.46) and 1.97 (95% CI: 1.14-3.40) in the fourth quartile of B2M compared with the first quartile, respectively. However, no interactive relationships were found in subgroup analysis by estimated glomerular filtration rate or hs-CRP in the above associations, neither in the distribution of Gensini score (p for interaction>0.05 for both)., Conclusion: Our data indicated that B2M was an independent risk factor of coronary stenosis in patients with acute coronary syndrome., (Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)