Purpose: Coronary artery disease (CAD) and its related mortality differ between both sex. We study the sex difference in the occurrence of major adverse cardiac events (MACE) among patients undergoing MPI for the detection of CAD and the predictors of MACE among those populations.Methods: This is a prospective cohort study involving patients with known or suspected CAD undergoing MPI for ischemia evaluation from January 2018 to July 2020. All patients were subjected to resting and exercise stress ECG, Gated 99mTc-Sestamibi (MIBI) myocardial perfusion SPECT (GSPECT) using one day stress/rest protocol. All patients were followed up for 1 year or till the occurrence of cardiac event whichever was earlier.Results: one-hundred and sixty-eight patients were enrolled. The mean follow-up period was 13.8 ± 5.3 months. MACE occurred in 25 patients. There was significant difference between MACE & non-MACE groups regarding sex with more MACE among females. High SDS score, high SWTS score, DM and female sex were independent predictors for MACE.Conclusion: MACE is more among women, and female sex is an independent predictor of MACE in CAD patients. Abnormal MPI with higher SDS and SWTS scores are independent predictors for MACE. Females have different model in MACE prediction than males.