BACKGROUND: The cut-off value of intravascular ultrasound (IVUS) minimum lumen area (MLA) 4 mm2 is currently used for the prediction of future clinical events in patients with proximal epicardial coronary artery disease. OBJECTIVES: We assessed the 2-year clinical events in patients with angiographically intermediate lesions with IVUS MLA <4 mm2 in non-intervened non-proximal epicardial coronary artery. METHODS: We retrospectively enrolled 55 patients (28 males, 63.29.1 years) with angiographically intermediate lesions (diameter stenosis 30-70%) with IVUS MLA <4 mm2 in non-intervened non-proximal epicardial coronary artery with reference lumen diameter between 2.25 and 3.0mm. We evaluated the incidences of 2-year clinical events (cardiac death, nonfatal myocardial infarction, cerebrovascular accidents, and target lesion and target vessel revascularizations) after medical therapy. RESULTS: Most of the patients had stable (40%) and unstable anginas (44%). The incidences of hypertension and diabetes mellitus were 58% and 26%. IVUS MLA was 3.560.41 mm2 and plaque burden was 64.17.0%. During 2-year follow-up, no cardiac death occurred with 3 noncardiac death (5.5%), no myocardial infarction occurred, no cerebrovascular accident occurred, and 5 target lesion (9.1%) and 6 target vessel revascularizations (10.9%) were performed. When we compared clinical, angiographic, and IVUS parameters between patients with and without 2-year follow-up clinical events, there were no differences between both groups. CONCLUSIONS: Although we enrolled small number of patients retrospectively in this study, the results of our study suggests that the event rates are relatively low with only medical therapy without any intervention, so the cut-off of IVUS MLA 4 mm2 may not be applied for patients with angiographically intermediate lesions with IVUS MLA <4 mm2 in non-proximal epicardial coronary artery.