Background. The prognostic value of myocardial perfusion imaging (MPI) in the very elderly population has not been addressed specifically. The aim of this study was to examine the characteristics of the octogenarian population referred for MPI and the prognostic value of the procedure in terms of patient gender. Methods. The study sample consisted of 162 consecutive patients (61 women, 101 men) of mean age 83 ± 3 years (range, 80-90) who underwent stress MPI. The duration of follow-up was 45±12 months. Outcome measures were cardiac-related death, and nonfatal myocardial infarction (MI). Results. Thirty-one major cardiac events (19%) were recorded, including 26 cardiac deaths and 5 MI events, in 6 of the 61 women (10%) and 25 of the 101 men (25%) (p < 0.03). The univariate predictors of cardiac death or MI, except of known coronary artery disease (CAD), were MPI variables: left ventricular (LV) dilatation, increased lung uptake, abnormal scan, and the presence and extent of myocardial ischemia. However, the only predictors for major cardiac events were: LV dilatation (OR = 6.9, 95% CI 2.7-17.4, p < 0.0001) and ischemia by scan (OR = 2.75, 95% CI 1.09-6.96, p < 0.03). The Kaplan Meier curve demonstrated significant differences in survival between patients with or without LV dilatation and patients with or without ischemia. Conclusions. LV dilatation and myocardial ischemia were useful predictors of cardiac death and MI in octogenarian patients with CAD or with suspicion of CAD.