Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although an association between some forms of vascular retinopathy and cardiovascular disease has been described, its predictive role in ischemic heart disease has not been sufficiently clarified. Methods Prospective cohort of 107 patients with medical indication for coronary angiography who underwent funduscopic examination to assess the presence of retinopathy. We recorded the occurrence of new acute coronary syndromes, the detection of perfusion defects in ischemia tests, the need for new catheterization and revascularization, and hospital readmission for cardiovascular causes with a median follow-up of 10 years. Results The median age was 67 years. A total of 39.3% were women, and 91.2% presented some cardiovascular risk factor, the most frequent being arterial hypertension in 78.5%, followed by dyslipidemia in 57% and diabetes in 32.7%. At the start of follow-up, 84.1% had some type of vascular retinopathy, with 46.3% of patients having high-grade retinopathy. In coronary angiography, up to 55% presented significant coronary artery disease, and angioplasty was performed in 39% of cases. During follow-up, only 2.9% of patients suffered ACS, 15% presented pathological myocardial SPECT, up to 14% underwent a new coronary angiography and 6.5% required new myocardial revascularization. The presence of advanced vascular retinopathy was associated with a higher rate of defects on Tc99 perfusion scintigraphy (p=0.002); a higher rate of coronary angiography (p=0.001) and myocardial revascularization (p=0.045). In addition, in the survival analysis, ischemia development was observed in earlier SPECT (103.13±4 vs 116.3±1.9 p=0.01), as well as earlier myocardial revascularization (109.72±3.5 vs 118.8±0.1 p=0.03) than in the rest of patients. Conclusions High-grade vascular retinopathy is associated with more and earlier inducible ischemia as well as more need for revascularization. The performance of fundus imaging in patients with suspected ischemic heart disease may be useful for long-term stratification.