© 2015 Wolters Kluwer Health, Inc. All rights reserved.Objective Increase in epicardial adipose tissue (EAT) thickness is associated with subclinical and manifest coronary artery disease. In addition, it is associated with the severity and extent of coronary atherosclerosis. We aimed to investigate whether increased EAT thickness is associated with adverse cardiovascular outcomes. Patients and methods Two hundred consecutive patients who were admitted with stable angina pectoris, unstable angina pectoris or acute myocardial infarction (MI), and had undergone coronary angiography were included and followed for revascularization, nonfatal MI, hospitalization for heart failure and cardiovascular death for 26 (5-30) months. Results There were significantly more revascularizations, nonfatal MI and cardiovascular death in patients with an initial EAT thickness more than 7mm (P<0.001 for all). Significant predictors of cardiovascular death were identified as an EAT thickness more than 7mm [hazard ratio (HR) 1.9, 95% confidence interval (CI) 0.4-8.3, P=0.039] and diabetes (HR 3.42, 95% CI 0.7-17.5, P=0.014) in the multivariate Cox regression analysis. Event-free survival for cardiovascular death in the EAT up to 7mm group was 97.9%, whereas it was 90.7% in the EAT more than 7mm group (P=0.021). In addition, significant predictors of MI were identified as an EAT thickness more than 7mm (HR 2.4, 95% CI 0.6-10.0, P=0.021) and diabetes (HR 3.4, 95% CI 1.0-11.2, P=0.04). Event-free survival for MI in the EAT up to 7mm group was 96.4%, whereas it was 68.2% in the EAT more than 7mm group (P=0.001). Conclusion Increase in EAT thickness independently predicts adverse cardiac events including MI and cardiovascular death.