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Background: Neurohumoral activation of the heart can be monitored by measurements of systemic levels of natriuretic peptides, such as BNP. Patients with non ST-elevation myocardial infarction (NSTEMI) with elevated BNP levels had an increased mortality rate when compared with those with lower levels. The SYNTAX score is a novel anatomical tool characterizing coronary vasculature and grades the complexity of coronary artery disease. Patients and methods: The study included 58 patients with NSTEMI “Group I” (72.5%) and 22 patients as a control “Group II” (27.5%) with typical chest pain, and coronary angiography revealed healthy coronaries. Analysis of blood samples for troponin-I, CKMB, and BNP levels was performed within 24 h of hospital admission, all patients underwent echocardiographic examination to exclude systolic dysfunction. Both groups were referred to coronary angiography. Results: This study included 58 patients with NSTEMI “Group I” (72.5%) and 22 patients as a control “Group II” (27.5%), the serum level of BNP was significantly higher in patients with the NSTEMI “group I” (37.7 ± 32.06) than the control “group II” (1.82 ± 5.9) p value (0.0001). The levels of BNP were positively correlated with the LAD involvement in coronary angiography. There was a positive correlation between the serum level of BNP and number of coronary vessels involved (r = 0.75) and Degree of SYNTAX score (r = 0.78). Conclusion: There was a significant relationship between the serum level of BNP and number of coronary arteries involved and complexity of the lesions in NSTEMI as regards SYNTAX score.