We aimed to compare retinal vascular density in optical coherence tomography Angiography (oct-A) between patients hospitalized for acute coronary syndrome (AcS) and control patients and to investigate correlation with angiogenesis biomarkers. patients hospitalized for an acute coronary syndrome (AcS) in the intensive care Unit were included in the "high cardiovascular risk" group while patients without cardiovascular risk presenting in the ophthalmology department were included as "control". Both groups had blood sampling and OCT-A imaging. Retina microvascularization density in the superficial capillary plexus was measured on 3 × 3 mm angiograms centered on the macula. Angiopoietin-2, TGF-β1, osteoprotegerin, GDF-15 and ST-2 were explored with ELISA or multiplex method. Overall, 62 eyes of ACS patients and 42 eyes of controls were included. ACS patients had significantly lower inner vessel length density than control patients (p = 0.004). A ROC curve found that an inner vessel length density threshold below 20.05 mm −1 was moderately associated with AcS. Significant correlation was found between serum levels of angiopoietin-2 and osteoprotegerin, and retinal microvascularization in OCT-A (R = − 0.293, p = 0.003; R = − 0.310, p = 0.001). Lower inner vessel length density measured with oct-A was associated with AcS event and was also correlated with higher concentrations of angiopoietin-2 and osteoprotegerin. In spite of the improvements in diagnosis and treatment of cardiovascular diseases (CVD), aging of population and urbanization make CVD one of the world's major disease burdens 1,2. Indeed, CVD remain a main cause of premature deaths and disability worldwide, with an estimated 16.7 million deaths in 2010, and projections show an overwhelming 23.3 million by 2030 3. Cardiovascular risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus lead to systemic inflammation, vascular and cardiac oxidative stress, which contribute to coronary dysfunction and microvascular impairment 4. Thus, coronary macro and microvascular alterations are closely associated and together contribute to the pathophysiology of myocardial ischemia 5. The assessment of myocardial microvascularization is then of major interest in order to estimate the risk of acute coronary events; however, only invasive procedures, using intra vascular contrast agents, are currently available 6 .