The association of elevated serum uric acid (UA) with cardiovascular events in patients with severe coronary artery stenosis was examined. Patients with stenosis≥ 75%(n= 8,832) were followed for" all events"(cardiovascular events and all-cause mortality) for 3 years. The group was divided into quartiles based on baseline UA level. The incidence rate of all events was significantly different among quartiles (58.3, 56.5, 61.2, 76.3/1,000 patients-year, P< 0.001). Cox's proportional hazard regression analysis showed that the hazard ratio (HR) for all events was 1.25 [95% confidence interval (CI): 1.07-1.45, P< 0.01] in the highest quartile (UA≥ 6.8 mg/dl). The group in which UA increased≥ 1.0 mg/dl after 6 months had significantly higher cardiovascular events rate than the group in which UA did not change (70.6 vs 58.8/1,000 patients-year, P= 0.042). Propensity score matching was performed and 4,206 patients were divided into the highest quartile and the rest. High UA remained an independent predictor of all events (HR 1.25, 95% CI 1.06-1.43). However, no significant difference was observed between the group with increased UA≥ 1.0 mg/dl and the group with unchanged UA level. Elevated UA is an independent predictor of cardiovascular events and all-cause mortality combined in patients with coronary artery stenosis.(Circ J 2009; 73: 885-891)