Coronary artery disease (CAD) is the first cause of mortality in people living with diabetic foot syndrome (DFS). Moreover, CAD are widely underdiagnosed and then, undertreated in these subjects where obstructive CAD has been observed in over 50% of the cases. Coronary artery calcium score (CACS) has been shown to be a valuable tool in the screening of CAD in normoglycemic and diabetic subjects. However, the effectiveness of CACS evaluation in predicting a severe CAD has never been studied in patients with DFS. We assessed the significance of coronary artery calcium score in predicting the presence of critical coronary artery stenosis in need of intervention in subjects with diabetes mellitus and diabetic foot ulcers without history or acute clinical signs of CAD. This is a single-center, prospective cohort study including 198 consecutive patients with DM admitted in our department for a diabetic foot ulcer who underwent a CACS estimation (mean age 68±11 yrs, 36.4% females, median CACS 885 Q1 150, Q3 1990). Of those patients, 106 underwent coronary artery angiography (mean age 67±10 yrs, 37.0% females, median CACS 1175 Q1 620, Q3 2300) and 72 were treated with a percutaneous coronary artery angioplasty (mean age 66±10 yrs, 20.8% females, median CACS 1175 Q1 576, Q3 2490). We observed that a higher CACS independently predicts endovascular coronary artery treatment with an odds ratio of 1.873 (IC 1.144-3.068). CACS may be a valuable screening tool for predicting severe coronaropathy in subjects with diabetic foot syndrome and no previous ASCVD.