Background: Carotid intima-media thickness (CIMT) is a predictor of major adverse cardiovascular events (MACE) in general population, which suggests CIMT as a screening tool in asymptomatic subjects. However, it is still controversial whether CIMT is associated with MACE especially in patients with coronary artery disease (CAD). Subjects: The study population consists of 1473 consecutive patients with CAD. They were followed up for a mean of 40.7 months (maximum 126 months) for MACE. Results: Patients (n=738) with thick CIMT (���0.78mm, mean 0.94짹0.15mm) were older (62.7 vs. 56.5 yrs, p<0.001), higher prevalence of hypertension (55.1% vs. 43.7%, p<0.001), diabetes mellitus (26.8% vs. 20.7%, p=0.006), lower ejection fraction (64.1% vs. 65.2%, p=0.031), higher prevalence being treated with revascularization (44.5% vs. 35.8%, p=0.001), higher level of fasting blood sugar (133mg/dL vs. 118mg/dL, p<0.001), lower HDL-cholesterol (41.8mg/dL vs. 43.5mg/dL, p=0.004), higher Hs-CRP (0.26mg/dL vs. 0.22mg/dL, p=0.021), higher prevalence of carotid plaque (41.9% vs. 19.0%, p<0.001) and more use of calcium channel blockers (31.9% vs. 25.8%, p=0.012) than those (n=735) with thin CIMT (<0.78mm, mean 0.67짹0.07mm). In univariate analysis, patients with thick CIMT had higher chance of hard MACE (death, acute myocardial infarction, stroke, [8.7% vs. 5.4%, p=0.016]), restenosis (13.6% vs. 6.7%, p<0.001), target lesion revascularization (9.3% vs. 4.9%, p=0.001), hospitalization for congestive heart failure (3.3% vs. 1.2%, p=0.009) compared than those with thin CIMT. Multivariate Cox regression analysis showed that the independent predictors of total MACE were CIMT (HR 1.498, 95% CI 1.103 to 2.033, p=0.010), low ejection fraction (HR 1.405, 95% CI 1.049 to1.883, p=0.023), and carotid plaque (HR 1.378, 95% CI 1.016 to 1.869, p=0.039). Conclusion: CIMT is associated with long-term MACE even in patients with CAD during more than 3-years follow up period, which suggest that CIMT has an important role in secondary prevention.