Background Peripheral microangiopathy occurs in various diseases. However it is not known whether changes in the peripheral microcirculation are present in patients with coronary heart disease (CHD). Methods Two hundred and nineteen patients were enrolled. They were allocated to a control group and a CHD group according to coronary angiography findings and underwent nail fold videocapillaroscopy. Propensity score matching was used to match the two groups in a 1:1 ratio. Peripheral microangiopathy parameters were compared between the groups, and correlation were assessed between changes in the peripheral microcirculation and the severity of CHD. Results Overall, 95 patients were included in the control group and 124 in the CHD group. Patients in the CHD showed reduced capillary lengths, increased thrombosis, abnormal papilla and subpapillary venous plexuses, and a higher proportion of total score 2 compared with the controls. CHD severity was positively correlated with the numbers of crossed capillaries, thrombosis, abnormal papilla and total Score 2. After propensity score matching analysis, reduced apical width and capillary length were observed, while abnormal papillary and subpapillary venous plexuses were increased in patients with CHD, together with increases in the total scores. Conclusion The findings demonstrated that the effectiveness of peripheral microangiopathy in assessing CHD severity, providing a basis for CHD screening.