Out-of-hospital cardiac arrest remains a serious clinical problem with a survival rate of less than 5%. A recent study showed that acute coronary artery occlusion is found in almost half of survivors of out-of-hospital cardiac arrest and occurs most often in patients with no past history of coronary artery disease. Detection and management of risk factors for coronary artery disease and screening of high-risk patients may therefore be effective in reducing the rate of sudden death. Furthermore, optimal management of patients with overt coronary artery disease including changes in life style, up-to-date drug regimens, revascularization when necessary and implantable defibrillators in selected cases may also lower the incidence of sudden death. Primary and secondary prevention of coronary artery disease should be included in out-of-hospital cardiac arrest training programs to increase their efficacy and diffusion.