OBJECTIVES: The purpose of this study was to assess whether MSCTA may be useful for risk stratification of patients with suspected CAD at intermediate pre-test likelihood according to Diamond and Forrester. Design and PATIENTS: MSCTA images were evaluated for the presence of significant CAD in 316 included patients (60% male, average age 57+/-11 years) with suspected CAD and an intermediate pre-test likelihood according to Diamond and Forrester. Patients were followed in time for the occurrence of an event. MAIN OUTCOME MEASURES: A combined endpoint of all cause mortality, non-fatal infarction, and unstable angina requiring revascularization. RESULTS: Significant CAD was observed in 89 patients (28%), whereas normal MSCTA or non-significant CAD was observed in the remaining 227 (72%) patients. During follow-up (median 621 days (95%-confidence interval: 408-835) an event occurred in 13 patients (4.8%). The annualized event rate was 0.8% in patients with normal MSCT, 2.2% in patients with non-significant CAD and 6.5% in patients with significant CAD. Moreover, MSCTA remained a significant predictor (p<0.05) of events after multivariate correction. CONCLUSIONS: Our results suggest that in an intermediate pre-test likelihood population, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasize the usefulness of non-invasive imaging with MSCTA in this patient population.