Background: Current evidence supporting the predictive value of coronary artery calcium scores (CACs) and coronary computed tomography angiography (CCTA) for adverse cardiac events in low-risk CAD patients is based on short follow-up periods. However, a long latency between the onset of coronary artery disease (CAD) and the occurrence of adverse events warrants longer follow-up periods. Methods: We reported our experience on the predictive power of CACs and CCTA for cardiac deaths and hospitalization in low risk chest pain patients followed for five years. In total, we enrolled 346 patients (mean age=62.07: male=53%) presenting with chest pain, no prior CAD on CCTA and negative to low CACs. The primary endpoint was cardiac death and hospitalization for cardiac causes. Results: During follow-up, six patients died due to non-cardiac causes (old age, cancer or stroke) and excluded from analysis (person-time follow-up rate=99.13%). In the remaining 340, none achieved the primary endpoint. There were no reported cases of cardiac deaths or hospitalization for cardiac causes (event rate = 0%). All patients were free of coronary artery problems. Conclusion: In low-risk chest patients, CACs and CCTA is an excellent predictor for up to five year event-free CAD, cardiac death and hospitalization for cardiac causes.