Aim. Cardiac troponins are the most preferred biomarkers in the evaluation of acute coronary syndromes (ACS). The aim of our study was to examine the association between high sensitive troponin T (hs-TnT), and neutrophil to lymphocyte ratio (NLR) and the complexity of ACS assessed by SYNTAX Score. Methods and results. 287 patients who underwent coronary angiography were studied (215 male, mean age 62.0 +/- 12.7 years). 133 patients were ST elevation myocardial infarction (STEMI), 154 patients were non-ST elevation (NSTE) ACS. The patients are divided to tertiles according to SYNTAX Score; SYNTAX Score <22 (n = 122) 22 < SYNTAX Score < 32 (n = 120), and SYNTAX Score >32 (n = 45). NLR was significantly correlated with SYNTAX Score in both STEMI and NSTE-ACS groups (r = 0.254, p = 0.003, r = 0.419 p < 0.001). Multiple linear regression analysis showed NLR predicted the angiographic severity of ACS assessed by SYNTAX Score in two groups (beta = 0.231, p = 0.004; beta = 0.232, p = 0.003). Hs-TnT was significantly correlated with SYNTAX Score in two groups (r = 0.327, p < 0.001; r = 0.430, p < 0.001). Multiple linear regression analysis showed hs-TnT was independent predictor of SYNTAX Score in STEMI and NSTE-ACS patients (beta = 0.292, p < 0.001; beta = 0.317, p < 0.001). Conclusion. Hs-TnT and NLR were significantly correlated with angiographic severity of ACS assessed by SYNTAX Score.