Background and Objectives: : Central blood pressure (BP) and pulsatile indices of BP have been shown to be more closely associated with coronary artery disease (CAD) and cardiovascular mortality than peripheral BP or steady indices of BP in several studies. However, invasive techniques are of limited value for screening and risk stratification in larger patient groups. Also, validity of non-invasive techniques still has a controversy. The aim of the study was to assess the relation between non-invasively and invasively assessed central BP derived pulsatile indices and the severity of coronary artery disease (CAD). Subjects and Methods: The study group consisted of 58 patients (38 male, age 63.4짹10.8) who admitted to our institute for elective coronary angiography from March 2010 to June 2010. We measured the aortic systolic, diastolic, and mean pressure waveforms using non-invasive (radial pulse tonometry, SphygmoCor짰) and invasive (fluid filled catheter at ascending aorta) technique. We used pulse pressure (PP), fractional PP (FPP, the ratio of PP to mean pressure) and pulsatility index (PI, the ratio of PP to diastolic pressure) to estimate the aortic pulsatility. Significant CAD was defined as having ���50% stenosis of at least one of its segments or prior coronary revascularization. The extent of CAD was defined according to the number of coronary vessels with ���50% stenosis. The severity of CAD was assessed by Gensini score. Results: Invasively assessed aortic PP, FPP and PI were significantly higher in patients with CAD than without CAD (PP, 57.4짹14.7 vs. 47.2짹14.9 mmHg [p=0.043]; FPP, 0.61짹0.12 vs. 0.52짹0.14 [p=0.046]; PI, 0.83짹0.21 vs. 0.68짹0.23 [p=0.049]), but non-invasively assessed indices did not show significant differences between two groups. In univariate analysis, invasively assessed aortic PP, FPP and PI were significantly correlated with Gensini score, but non-invasively assessed indices were not correlated. In multivariate analysis, after controlling age, gender, smoking, hypertension, diabetes, body mass index, the history of myocardial infarction, cholesterol and creatinine, the correlation was significant as the univariate analysis. The non-invasively measured aortic PP underestimated invasively measured aortic PP (mean difference: 6.1 mmHg). Conclusion: Invasively assessed aortic PP, FPP and PI were related to the presence and severity of CAD, but non-invasively assessed indices were not related. Non-invasively assessed pulsatile indices may be underestimated.