Objectives: Carotid plaque is associated with poor clinical outcomes in the elderly. However, it is still unclear whether it has long-term prognostic significance in patients with coronary atherosclerosis. Methods: Nine hundred ninety three consecutive patients (mean 60 yrs old, 555 males) underwent coronary angiogram and carotid intima-media thickness (CIMT) measurement since January 2000. Results: There were 24 deaths, 16 acute myocardial infarction, and 28 strokes during mean 27.3 months follow up period (max 87 months). Patients with carotid plaque (n=338, 183 males) were older (mean 64.8 yrs vs. 56.8 yrs old, P<0.001), more prevalence of hypertension (58.6% vs. 43.2%, P<0.001), diabetes (29.0% vs. 21.8%, P=0.013), smoking (37.3% vs. 29.2%, P=0.010), previous myocardial infarction (15.1% vs. 6.6%, P<0.001), acute coronary syndrome (45.9% vs. 36.7%, P=0.010), more frequent use of aspirin (93.8% vs. 86.9%, P=0.007), calcium channel blocker (36.3% vs. 29.7%, P=0.038), angiotensin converting enzyme inhibitor (55.8% vs. 47.7%, P=0.017), and statin (59.2% vs. 47.7%, P=0.001), while less use of angiotensin receptor blocker (4.0% vs. 11.5%, P=0.030) than those without carotid plaque (n=655, 372 males). Patients with carotid plaque had increased major adverse cardiovascular events (8.6% vs. 5.0%, P=0.029), which is mainly caused by higher mortality rate (4.7% vs. 1.2%, P=0.001). Conclusions: Patients with carotid plaque is associated with increased mortality in patients with coronary atherosclerosis.