Abstract： Objective To analyze the predictive value of cardiovascular magnetic resonance(CMR)myocardial perfusion imaging combined with CT fractional flow reserve(CT-FFR)parameters in predicting cardiovascular adverse events in obstructive coro-nary heart disease.Methods A prospective study was conducted in 180 patients with obstructive coronary heart disease(coronary ar-tery stenosis≥50%)who were treated in the Second Affiliated Hospital of Hebei North University from June 2018 to June 2022.All patients underwent CT angiography and CMR myocardial perfusion imaging,and the occurrence of cardiovascular adverse events within 1 year was collected by on-site follow-up or telephone follow-up.Univariate and multivariate logistic regression models were used to an-alyze the influencing factors of cardiovascular adverse events;ROC curves were used to assess the predictive efficacy of different predic-tion models for the occurrence of cardiovascular adverse events.Results A total of 45 patients developed cardiovascular adverse e-vents(observation group),and the remaining 135 patients were controls.Compared with the control group,the age,male ratio,smok-ing patient ratio,total cholesterol level,diabetes mellitus ratio,hyperlipidemia ratio,first-pass perfusion time and myocardial delayed enhancement signal value of the observation group increased,while the CT-FFR and maximum slope(Slopemax)index decreased,and the differences were statistically significant(P<0.05).Further univariate and multivariate logistic analysis of the above indica-tors showed that age,male,smoking,diabetes,hyperlipidemia,the first pass perfusion time,and the value of myocardial delayed en-hancement signal were independent risk factors for adverse cardiovascular events in patients with obstructive coronary heart disease(P<0.05),and the CT-FFR and Slopemax were its protection factors(P<0.05).The ROC area under the curve was 0.721(95%CI:0.645-0.812)when only using clinical parameters(including age,gender,smoking history,hypertension,diabetes,hyperlipidemia and other diseases).The ROC area under the curve of CMR myocardial perfusion imaging combined with CT-FFR was 0.793(95%CI:0.713-0.873).The ROC area under the curve with clinical parameters added on the basis of CMR myocardial perfusion imaging combined with CT-FFR was 0.893(95%CI:0.835-0.952).Conclusion CMR myocardial perfusion imaging combined with CT-FFR is an independent forecast factor for the development of cardiovascular adverse events in patients with obstructive coronary heart disease.The addition of CMR myocardial perfusion imaging combined with CT-FFR to clinical models significantly improves the predic-tive efficacy for the risk of cardiovascular adverse events in patients with obstructive coronary heart disease.