Objective To evaluate coronary artery stenosis based on coronary computed tomography angiograpy (CCTA), and to explore the influence of generalized anxiety disorder (GAD) on coronary artery disease (CAD) and the influence of gender on CAD risk factors and clinical characteristics. Methods Altogether 1 117 patients who underwent CCTA in Tianjin Medical University General Hospital from Apr. 2018 to Jun. 2019 were evaluated with Duke CAD index and generalized anxiety disorder 7 (GAD-7). The relationships between GAD, gender and high-risk CAD were analyzed by binary logistic regression. Results A total of 1 099 patients were enrolled, including 460 males (41.9%) and 639 females (58.1%). GAD was a risk factor for high-risk CAD (odds ratio[OR]=1.071, 95% confidence interval[CI] 1.013-1.134, P=0.017). Compared with men, women had higher prevalence of GAD (20.3%[130/639]vs 7.0%[32/460], P<0.01), but GAD was not a risk factor of high-risk CAD in women (OR=1.037, 95% CI 0.954-1.129, P=0.392). Age, GAD, diabetes mellitus, hyperlipidemia and smoking were the risk factors of high-risk CAD in men (all P<0.05), while only age and hypertension were risk factors in women (both P<0.05). Conclusion Women are more likely to suffer from GAD, but it is not a risk factor of high-risk CAD in women. For women with suspected CAD symptoms, the symptoms may be caused by GAD rather than CAD, so more attention should be paid to the influence of psychological factors; for men with GAD, we should focus on screening of high-risk CAD in clinic.