Background: Silent myocardial ischemia in asymptomatic subjects with no history of myocardial infarction (MI) or angina is a frequent condition in diabetic patients. Therefore the detection of subclinical atherosclerosis in asymptomatic diabetic patients is important. The aim of the present study was to investigate the prognostic value of coronary 64-slice multi-detector computed tomography (MDCT) in asymptomatic diabetic patients. Methods: In an observational, retrospective, single-center study, 412 persons (mean age, 56.2 짹 6.5 years; 308 males) underwent MDCT as part of their general medical checkups from November 2005 to December 2008. The patients had no past history of coronary artery disease, no typical chest pain, and no evidence of myocardial ischemia. The primary endpoint of the study was the occurrence of major adverse cardiac events (MACE) defined as cardiac death, non-fatal MI, unstable angina requiring hospitalization, and target lesion revascularization during a median follow-up of 519 짹 119 days. Results: 130 (31.7 %) of patients had hypertension, 65 (15.9 %) hyperlipidemia, and 113 (27.5 %) current smokers. 314 (76.2 %) patients had non-obstructive coronary lesion and 98 (23.8 %) patients obstructive coronary lesion (luminal stenosis of the coronary artery of ��� 50 % with the presence or absence of coronary calcium). Three (0.1 %) patient presented with unstable angina requiring revascularization in non-obstructive group. However, 6 patients (6.1 %) developed MACE in obstructive group (one patient: sudden cardiac death, 2 patients: acute MI, 3 patients: unstable angina requiring revascularization). Patients with obstructive coronary lesion had a significantly higher event rate than those without obstructive coronary lesion (6.1 % vs. 0.1 %, p<0.001). Conclusion: Although the event rate is low, MDCT have a high prognostic value for detection of subclinical atherosclerosis in asymptomatic diabetic patients.