There is a lack of information on the prognostic value of local high velocity in coronary arteries during echocardiography. The aim of the study described here was to define the prognostic value of local velocity >70 cm/s in the left main, anterior or circumflex artery during echocardiography. There were 412 patients in the prospective study. Death, non-fatal myocardial infarction, acute pulmonary edema, acute coronary syndrome and revascularization were defined as major adverse cardiac events (MACEs). Over 10.5 mo, there were 207 patients with MACEs. Seventeen patients died, 10 had non-fatal acute cardiac events and 184 underwent revascularization. Deaths occurred in patients with high local velocity (6.4% vs. 0%, p < 0.009). Acute cardiac events occurred in 10% versus 0% (p < 0.003). MACEs were observed in 62% versus 0% (p < 0.0000001). Only maximal velocity was an independent prognostic predictor of death (odds ratio = 1.02, 95% confidence interval: 1.01–1.03, p < 0.02) and MACEs (odds ratio = 1.04, 95% confidence interval: 1.02–1.05, p < 0.0001). The success rate of coronary artery visualization for at least one segment was 91%.