The coronary artery calcification (CAC) score determined by multi-detector row computed tomography (MDCT) predicts the onset of coronary artery disease (CAD). In addition, pulse wave velocity (PWV) also predicts the mortality of CAD. Therefore, the aim of this study was to assess whether or not the CAC score is associated with PWV. The subjects consisted of 535 consecutive patients with suspected CAD who underwent MDCT. Brachial-ankle (ba) PWV, ankle-brachial index, % mean artery pressure (MAP) and upstroke time (UT) were measured. When the subjects were divided into three groups according to the CAC score [low (0-12 IU), intermediate (13-445) and high (> or = 445)], the classification score was significantly associated with age, sex, prevalence of hypertension and diabetes mellitus, systolic blood pressure, plasma levels of high-density lipoprotein cholesterol and uric acid, medication by angiotensin II receptor blocker and calcium channel blocker, PWV, %MAP and UT. In a multivariate logistic regression analysis, UT (p<0.0001), sex (p=0.0001), age (p=0.0003) and PWV (p=0.0276) remained significant independent variables for the classification. UT was most significantly associated with the classification according to the CAC score. Measurement of UT should be performed before MDCT angiography, because the assessment of coronary artery lumen narrowing by MDCT can not be diagnosed in patients with severe calcification.