OBJECTIVES To evaluate the accessibility of coronary arteries from chest CT examinations acquired without ECG gating or beta-blockade. MATERIALS AND METHODS Two hundred forty-two patients (median heart rate: 81.7 bpm) underwent a non-ECG-gated CT examination with high pitch and high temporal resolution. Image analysis was obtained by consensus between two readers. RESULTS The percentage of accessible segments was 88% at the proximal level (i.e. 4 segments), 75% at the proximal and mid-segment level (i.e. 7 segments), and 61% and 48% when considering 10 and 15 segments, respectively. The mean (± SD) number of accessible segments per patient was 3.5 ± 0.78 and 5.2 ± 1.50 when considering four and seven segments per patient, respectively. The percentage of patients with four segments accessible was 67% (126/242), decreasing to 23% (55/242) with seven segments accessible and 3% (7/242) with ten segments accessible, while the entire coronary artery tree was not accessible for any of the patients. No significant difference was found in the patients' mean hearts with four, seven, or ten accessible segments (P = 0.4897). CONCLUSION Diagnostic image quality was attainable at the level of proximal segments in 67% of patients, while proximal and mid-coronary segments were accessible in 23% of patients. Main Messages • High-pitch and high-temporal resolution scanning modes make accessible proximal coronary arteries on non ECG-gated chest CT angiograms • It is not necessary to administer beta-blockers to achieve good results. • Tobacco-related cardiovascular disorders could benefit from this scanning mode.