Aim To investigate the clinical characteristics of coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) in female patients with syndrome X. Methods In 26 consecutive patients with syndrome X (abnormal exercise test results and angiographically normal coronary arteries) and 22 normal group women (normal exercise test and angiographically normal coronary arteries) with chest pain, EBCT was performed. Meanwhile, the concentration of serum lipid and plasma oxidized low density lipoprotein (ox LDL) was detected; the risk factors of coronary artery disease were evaluated as well. Results The prevalence of coronary calcification in the syndrome X group was 73% (19 in 26 patients) compared with 18% (4 in 22 patients) in the normal group (p<0.05). The mean risk factors of coronary artery disease in the women with syndrome X and positive CAC were greater than those of the normal group (1.8±1.3 vs. 1.1±0.9, p<0.05), while the concentration of plasma ox LDL was higher too (52.38±6.89 vs. 39.92±7.87, p<0.05). However, the mean CAC score of the syndrome X group with positive CAC was greater than the normal ones with positive CAC, and the number of calcification was much greater, despite postmenopausal or not menopausal. Conclusions EBCT may be useful in detection of atherosclerosis in women with syndrome X who demonstrate normal coronary arteries at angiography. Careful evaluation and necessary therapy should be done in women with syndrome X and positive CAC.