Background Current guidelines for the management of patients with acute myocardial infarction (AMI) recommend the GRACE score for risk stratification with assessment of admission variables. The syntax score (SS) is a comprehensive angiographic scoring system that is derived entirely from the coronary anatomy and lesion characteristics. We investigated the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX Score (SS) and GRACE Score (GS) in patients with AMI. Patients and Methods From the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 614 consecutive patients hospitalized for an AMI from 1st march 2011 to 30 august 2012 and who underwent coronary angiography were included. Patients were analyzed into 3 tertiles of risk based on GS. Results The tertiles of risk were defined as low (n=205)(GS<133), intermediate (n=204)(GS:133–165), and high risk (n=205)(GS: >165). Age and co-morbidities increase gradually with increased GS risk. Also, the number of diseased vessels on coronary angiography increased across the tertiles (p<0.001). In-hospital mortality increased from the low to the highest tertile (0.5%, 2.0% and 11.8%, p<0.001). Patients at high risk had significantly higher SS values compared with the intermediate and low GS risk (median (IQR) SS: 13(6–20) vs 9(4–15) vs 7(3–12), respectively, p<0.001). Moreover, SS was strongly correlated with GS (r=+0.254, p<0.001), and remained significant in patients with multivessel disease. By logistic regression analysis, both GS and SS score are significant correlate of hospital mortality (OR(95%CI)1.04(1.02–1.05), p<0.001 and OR(95%CI) 1.11(1.07–1.15)). Conclusion Although SS and GS don’t share any common items, they are strongly associated for prognostic information. Both scores allow for an accurate personalized assessment of patient risk.