【Abstract】 Objective: To analyze the predictive value of fractional flow reserve derived from coronary CTA (FFRCT) and plaque characteristics for major adverse cardiac events (MACE) in patients with coronary artery disease (CAD), and compare with myocardial perfusion imaging (MPI). Materials and Methods: Eighty patients with suspected CAD patients who underwent coronary CTA and MPI within 3 months were retrospectively enrolled and followed up. Measurement parameters included FFRCT, atherosclerosis plaque characteristics, summed stress score, summed difference score, phase standard deviation (SD), phase histogram bandwidth (BW). The independent-sample t test, x 2 test were used to compare the difference between positive and negative MACE groups. ROC curve analysis was performed to evaluate the predictive value of FFRCT combined with plaque characteristics and MPI for MACE. Results: MACE occurred in 11 patients. FFRCT, rest diastole SD (RDSD) and rest diastole BW (RDBW) in positive MACE group were significantly lower than that in negative MACE group(all p＜0.05). Plaque length and non-calcified volume in patients with MACE were significantly higher(all p＜0.05). The AUC of FFRCT and plaque length for prediction of MACE was 0.80 and 0.81, while the predictive value of RDSD and RDBW was 0.62 and 0.56 respectively. Conclusions: FFRCT and plaque characteristics demonstrated a higher predictive value for MACE than phase analysis of MPI in CAD patients.