In several clinical studies, the diagonal earlobe crease has been statistically related to the presence of ischemic heart disease. Only one study of a relatively small number of hospitalized patients attempts to relate the earlobe crease with amount of stenotic coronary atherosclerosis demonstrated at necropsy. We examined the relationship between the degree of coronary atherosclerosis and the presence of a diagonal earlobe crease in 800 consecutive autopsies performed for medicolegal reasons and thus including a wide spectrum of subjects. Statistical analysis by the chi 2 test demonstrated a positive correlation (p less than 0.01) between the presence of the diagonal earlobe crease and obstructive coronary atherosclerosis narrowing on at least one major coronary artery greater than 75%. We conclude that the autopsy findings support the clinical observations that the diagonal earlobe crease is a cutaneous sign of obstructive coronary atherosclerosis and that the sign should be used accordingly.