Objectives: To examine whether serum levels of retinol-binding protein-4 (RBP4) are associated with coronary artery disease (CAD) and one-year prognosis. Methods: RBP4 levels were determined by ELISA kit (IBL. Germany) in 140 patients without type 2 diabetes undergoing coronary angiography for concern of CAD. Patients were divided into controls (normal coronary arteries, n=46) and CAD (≥50% diameter stenosis, n=94). CAD patients were followed up for average 12 months. Major adverse cardiac events (MACEs) including recurrent anginal, recurrent infarction, deteriorated heart failure and cardiac death were analyzed. Multivariate analysis was done to determine the association between RBP4 and composite MACEs during one-year follow up. Results: Compared to the controls, patients with CAD were elder, had higher prevalence of hypertension and smokers (all P<0.05). RBP4 levels were elevated in patients with CAD [(51.69±34.96) µg/mL vs (37.84±15.94) µg/mL] and smokers [(59.44±45.12) µg/mL vs (41.88±19.90) µg/mL] (all P<0.05). Meanwhile, patients suffering from MACEs (n=8) had higher levels of RBP4 than those without [(76.12±42.89) µg/mL vs (46.24±17.66) µg/mL, P<0.01]; these patients suffering from MACEs had higher ratio of RBP4 levels ≥70µg/mL than those without (37.50% vs 9.30%, P=0.018). Multivariate analysis demonstrates that RBP4 is an independent predictor of composite MACEs during one-year follow up (OR:1.091,95% CI:1.015-1.172, P=0.018). Conclusion: RBP-4 levels are associated with CAD and one-year prognosis. Patients with higher RBP-4 levels are at higher risk of MACEs.