This study aimed to investigate the relationship between MHR and coronary artery lesions. A total of 488 patients aged 40-84 years who had undergone coronary angiography were enrolled in the study. The patients were divided into groups based on the presence or absence of coronary artery lesions and the number of branches affected. Statistical analysis using SPSS 26.0 software was conducted to examine the relationship between MHR, relevant clinical indicators, and coronary artery lesions. Additionally, the predictive value of MHR for coronary artery lesions was evaluated using the receiver operating characteristic (ROC) curve. The results revealed significantly higher MHR values in the lesioned group compared to the non-lesioned group [0.45 (0.34-0.62) vs. 0.35 (0.26-0.45), P <0.001]. Even after adjusting for various factors such as gender, age, BMI, waist-hip ratio, smoking history, disease history, medication history, and relevant biochemical parameters, MHR remained a significant risk factor for coronary artery lesions (OR=14.041, 95% CI 1.746 to 112.899, P=0.013). The ROC curve analysis determined that an optimal diagnostic threshold of 0.435 for MHR exhibited a sensitivity of 0.546 and a specificity of 0.740 for coronary artery lesions. In conclusion, elevated MHR levels were found to be associated with coronary artery lesions. The study demonstrated that a higher MHR level corresponded to a greater percentage of patients with coronary artery lesions, particularly in cases with a lesion branch number of 3. Therefore, MHR could serve as a valuable tool for identifying individuals at risk of developing coronary artery lesions.