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Background: Coronary artery ectasia (CAE) is an uncommon but known finding in coronary angiography. We compared the neutrophil to lymphocyte ratio in patients with sole CAE and coronary artery disease (CAD) patients as well as normal coronary individuals who presented to our center. Methods: In this case-control study, we compared patients with lone coronary ectasia with two other groups: patients with CAD and normal coronary individuals. Demographic and clinical data of the ectatic patients were retrieved from the databank of our center and all variables, particularly neutrophil to lymphocyte ratio compared between the study groups. Results: A total of 233 patients with coronary ectasia met our criteria and were compared to 433 stenotic CAD patients and 466 normal coronary individuals. The neutrophil to lymphocyte ratio was significantly lower in the normal coronary individuals (P < 0.001). However, there was no significant difference between the coronary ectasia group and the CAD group. This difference was significantly lower in the normal coronary group (P < 0.001), while no difference was observed between the ectasia and the CAD group (P = 0.127). Conclusion: Higher neutrophil to lymphocyte ratio was present in patients with CAE and CAD patients than the normal coronary individuals.