Introduction: Clinical significance of descending thoracic aorta intima-media thickness (IMT) is still not clear,we sought to evaluate the prognostic significance of descending thoracic aorta and common carotid IMT in patients with coronary atherosclerosis. Methods: Angiographically proven 104 patients with coronary atherosclerosis were underwent transesphageal echocardiography for measurement of descending thoracic mean IMT and carotid scanning for common carotid IMT measurement. They were followed up for 50짹21 months. Results: With regards to thoracic IMT, those who had higher IMT (n=44, >0.21mm) had higher chance of stroke (6.7% vs. 2.8%, P=0.04), peripheral vascular disease (6.7% vs. 1.9%, P=0.02), and death (2.9% vs. 0%, P=0.04) than those who had lower IMT (n=60, ���0.21mm), while other MACE such as heart failure, and chronic kidney disease did not show any significant differences between two groups. In terms of common carotid IMT, peripheral vascular disease was more developed (8.7% vs. 1.9%, P=0.04) in those with higher IMT than in those with lower IMT, while the other MACE showed no significant difference. Conclusions: Increased descending thoracic intima-media thickness is associated with mortality, stroke, and peripheral vascular disease in patients with coronary atherosclerosis This study suggests that thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than the common carotid IMT.