Introduction: Serum uric acid have been reported to be an independent risk factor for coronary artery disease (CAD) and predictor of mortality in patients with CAD. But there is sex differences in serum uric acid level. We studied the influence of uric acid levels on major adverse cardiovascular event (MACE) in patients with CAD according to the gender. Methods: Of the 777 patients with angiographically proven CAD, 660 (male 57.3%) were followed up a median of 18 month (maximum 61 month). The MACE included acute myocardial infarction, cerebral infarction, coronary artery bypass graft, percutaneous coronary intervention due to de novo lesion during follow up, new onset congestive heart failure and sudden cardiac death. Results: In male patients, the variables predicting MACE are acute coronary syndrome (ACS) (hazard ratio (HR) 2.03, 95% confidence intervals (CI) 1.01 to 3.96, p=0.038), multi-vessel disease (HR 3.68, 95% CI 1.82 to 7.47, p=0.000) and serum uric acid levels (HR 1.23, 95% CI 1.01 to 1.50, p=0.044) by multivariate Cox regression analysis. In female patients, the variables predicting MACE are multi-vessel disease (HR 2.43, 95% CI 1.15 to 5.13, p=0.020) and highest uric acid quartile (HR 2.64, 95% CI 1.31 to 5.30, p=0.006) by multivariate Cox regression. Conclusions: In male patients with CAD, serum uric acid levels is a predictor of cardiovascular event, and in female, highest uric acid quartile is a predictor of it. This results suggest that uric acid have a threshold of effect on cardiovascular event in female.