Background: Guidance on the diagnostic approach to coronary artery disease (CAD) has diverged as the increasing complexity of atherosclerotic clinicopathologic correlations has been revealed. Foundational concepts linking stenosis, the ischaemic cascade and prognosis have been re-evaluated in light of the underwhelming results from the percutaneous revascularization of stenotic vessels. Instead, observations from noninvasive anatomical imaging have redefined risk, shifting the focus away from discrete lesions towards total atherosclerotic burden, and with it elevating the role of computed tomography (CT) in contemporary diagnostic pathways. Quantitative determination of atherosclerosis by Gensini score (GS) may be as important as other risk-factors for disease management. Angiographic scoring systems are strongly correlated with each other and with atherosclerotic plaque burden. Therefore, scoring systems appear to be a valid estimate of CAD plaque burden. Objective: This review article aims to role of GENSINI score in assessment CAD severity. Conclusions: GS were correlated to the severity of coronary lesions, especially with multivessel disease, CABG and implanted LIMA or drug eluting stent. GS reflecting severity of atherosclerosis is related to several cardiovascular risk factors, such as age, HDL, HTN, and diabetes. GS can provide valuable information about the severity and prognosis of CAD. Using GS to assess angiographic severity of CAD is potentially useful for predicting patient outcomes and benefit of therapies and can improve the quality of care.