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Reduced forced expiratory volume in 1 second percentage (FEV1%) predicted is closely related to cardiovascular mortality. However, evidence regarding the correlation between FEV1% predicted and the severity of coronary atherosclerosis observed on coronary angiography is still limited. We aimed to explore whether a decline in FEV1% predicted was associated with diffuse coronary atherosclerosis in hospitalized patients.A cross-sectional study enrolling hospitalized patients with cardiovascular symptoms undergoing both coronary angiography and lung function testing was conducted. The correlation between FEV1% predicted and angiographic characteristics, including the number of diseased vessels, total number of coronary lesions and Gensini score was analyzed.Eighty-five patients were included. Patients with ≥2-vessel disease had significantly lower FEV1% predicted than patients with <2-vessel disease (60.9% ± 19.7% versus 77.2% ± 19.7%, P < 0.001). FEV1% predicted was inversely related to the total number of coronary lesions (β = −0.029, P = 0.002) and Gensini score (β = −0.525, P = 0.006). FEV1% predicted was independently associated with ≥2-vessel disease (odds ratio = 0.961, P = 0.007), total number of coronary lesions (adjusted β = −0.039, P < 0.001) and Gensini score (adjusted β = −0.602, P = 0.005) after adjustment for other traditional cardiovascular risk factors. In the coronary artery disease subgroup, FEV1% predicted maintained an independent and negative relationship with ≥2-vessel disease, total number of coronary lesions and Gensini score.Reduced FEV1% predicted was closely associated with multivessel coronary disease and diffuse coronary atherosclerosis in hospitalized patients undergoing coronary angiography.