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Background Increased pulse-wave velocity (PWV) and decreased ankle-brachial index (ABI) are related to an increased risk of all-cause- as well as cardiovascular mortality. Aim of this study was to assess the predictive value of PWV and ABI in an emergence department (ED) setting. Methods We assessed ABI-, brachial-ankle (ba) PWV-, and carotid-femoral (cf) PWV in patients presenting to a high-volume tertiary care ED. Primary outcome was all-cause mortality in the long-term follow-up of these patients, which was evaluated via Austria´s federal statistical office. Results We included 1,041 patients (60 ± 17 years; 56.6% males) with various chief complaints (e.g., chest pain, dyspnea, atrial fibrillation). ABI and cfPWV could be measured in 952 (91.5) and 910 (87.4%), respectively. Values of ABI (1.03 ± 0.13) and cfPWV (10.1 ± 2.9 m/s) were found to be pathological in 13.4% and 44.8%, respectively. Median follow-up time was 540 [344–877] days. During this observational period, 8.1% of patients had died; the majority of deaths was classified as cardiovascular events. Overall mortality differed significantly between patients with pathological ABI or elevated cfPWV (P < 0.001) compared with those patients without pathological alterations. Even after multivariate cox-proportional hazard analysis (including age(-groups), sex, BMI and comorbidities), a pathological ABI (HR 0.07 [0.01–0.56], P = 0.01) and cfPWV (HR 1.13 [1.04–1.23], P = 0.003) were associated with overall mortality risk. Conclusion In unselected ED patients a pathological ABI or PWV are independent predictors for long-term mortality and may be used as an additional risk stratification tool in the emergency setting.