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To investigate the impact of anxiety on the prognosis of coronary artery disease (CAD) in patients of Chinese Han ethnicity and to explore the correlation between anxiety and the severity of coronary atherosclerosis.Between June 2007 and May 2009, 1007 hospitalized patients with CAD diagnosed by coronary angiography were recruited. The anxiety symptoms were investigated within 2 days after coronary angiography or percutaneous coronary intervention, using the Zung Self-Rating Anxiety Scale. The severity of coronary atherosclerosis was assessed using the modified Gensini score. One and a half years after discharge, the participants were evaluated at the outpatient clinic or by telephone. The primary outcome was the composite of all-cause death and nonfatal myocardial infarction (MI).A total of 917 (91.1%) patients were evaluated during a mean follow-up period of 17 months. Thirty-five deaths (26 of cardiovascular and 9 of other causes) and 5 nonfatal MIs occurred. The Zung Self-Rating Anxiety Scale score assessed during hospitalization was significantly and independently associated with the Gensini score (β = 1.35, p < .001). Adjusted Cox proportional hazards models showed that anxiety symptoms predicted all-cause death and nonfatal MI (adjusted hazard ratio = 2.43, 95% confidence interval = 1.24–4.75, p = .009).Anxiety was independently associated with the severity of coronary atherosclerosis and predicted worse outcome in patients with CAD of Chinese Han ethnicity.