Introduction: It is a matter of controversy whether uric acid is a predictor of cardiovascular event or not. We studied the influence of uric acid levels on major adverse cardiovascular event (MACE) in patients with coronary artery disease (CAD). Methods: Of the 777 patients with angiographically proven CAD, 660 were followed up a mean of 25 months (maximum 61 months). The MACE included acute myocardial infarction(AMI), cerebral infarction, coronary artery bypass graft, percutaneous coronary intervention due to de novo lesion during follow up (PTCA), new onset congestive heart failure (CHF) and sudden cardiac death. Results: In CAD patients with uric acid <3.88 mg/dL (lowest quartile) compared with those with uric acid levels >5.74 mg/dL (highest quartile), the MACE rate increased from 7.2% to 20.1%. In univariate Cox regression analysis, highest uric acid quartile is predictor of AMI (hazard ratio (HR) 13.00, 95% confidence intervals (CI) 1.45 to 116.31, p=0.022), CHF (HR 2.84, 95% CI 1.39 to 5.82, p=0.004) and MACE (HR 1.89, 95% CI 1.80 to 4.64, p=0.000). Serum uric acid levels is predictor of PTCA (HR 1.30, 95% CI 1.01 to 1.69, p=0.044), CHF (HR 1.27, 95% CI 1.02 to 1.58, p=0.033) and MACE (HR 1.22, 95% CI 1.05 to 1.41, p=0.009). In multivariate Cox regression analysis with 4 variables (Age, ACS, multi-vessel disease, uric acid levels), the variables predicting MACE are acute coronary syndrome (HR 3.08, 95% CI 1.84 to 5.15, p=0.000), multi-vessel disease (HR 1.74, 95% CI 1.06 to 2.85, p=0.029) and uric acid levels (HR 1.20, 95% CI 1.04 to 1.39, p=0.015). Conclusions: Serum uric acid is an independent predictor of cardiovascular event in patients with CAD.