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Background The purpose of this study was to analyze predictive performance of MCV in midterm ischemic events among SCAD patients undergoing elective PCI. Material/Methods We retrospectively included 226 consecutive patients with SCAD who received elective PCI. The patients were grouped based on MCV quartile values. The prognostic significance of MCV was assessed using univariate and multivariate Cox proportional hazard regression analyses. Results According to MCV quartile points (87.5 fL, 89.7 fL, and 92.4 fL, respectively), the included patients were divided into 4 groups, with an average follow-up of 34.2 months. There were 28 (48.3%) patients with stent thrombosis in the 1 st quartile, 24 (29.1%) in the 2 nd quartile, 18 (31.6%) in the 3 rd quartile, and 15 (27.8%) in the 4 th quartile (log-rank test, P =0.027). Multivariate analysis confirmed that MCV 1 st quartile (HRadj=2.047, 95% CI 1.041–4.026; P =0.038), ALT (HRadj=1.013, 95% CI 1.004–1.023; P =0.004) and number of PCI vessels (HRadj=1.198 95% CI 1.013–1.415; P =0.034) were risk factors for ischemic events. The restenosis rate in patients belonging to the MCV 1 st quartile was 2 times higher than that in MCV 2 nd , 3 rd , and 4 th quartile groups ( P =0.007). Conclusions MCV value may be independently correlated with restenosis in SCAD patients undergoing PCI. Low MCV predicts high risk of in-stent restenosis.