Background-Distal coronary flow velocity reserve (CVR) is significantly improved after a successful balloon angioplasty (PTCA). Furthermore, a postinterventional CVR Ͼ2.5 and a percent diameter stenosis (%DS) Յ35% are predictive for a low incidence of major adverse cardiac events (MACE) at 6 months of 16%. Similar results are lacking for coronary stenting. Methods and Results-In 150 patients, baseline and hyperemic coronary flow velocities were recorded with a Doppler guidewire distal to the target lesion and in an unobstructed reference artery before and after PTCA, after stenting, and at 6 months. Distal CVR and relative CVR (CVR rel ) were calculated. Logistic regression and receiver operating characteristic analyses were applied to determine prognostic cutoff values of CVR, CVR rel , %DS, and minimal lumen diameter separately and in combination to predict MACE at 6 months. After stenting, CVR (2.96Ϯ0.87 versus 2.40Ϯ0.7; Pϭ0.001), CVR rel (1.02Ϯ0.24 versus 0.81Ϯ0.24; Pϭ0.001), and minimal lumen diameter (2.98Ϯ0.56 versus 2.11Ϯ0.74 mm; Pϭ0.001) were significantly higher than after PTCA. Thirty-three patients developed MACE. A postinterventional CVR rel Ͼ0.88 was the best single predictor of MACE, with an incidence of 6.8%, whereas the combination of a CVR rel Ͼ0.88 and a %DS Յ11.2% predicted an incidence of MACE of 1.5%. Conclusions-Measurement of CVR rel and %DS after stent implantation are best suitable to predict MACE at 6 months.