Background <p>The coronary lumen volume to myocardial mass (V/M) ratio has been suggested as a quantitative metric of potential imbalance between coronary blood supply and myocardial oxygen demand. This study was designed to assess the prognostic value of the V/M ratio for predicting major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR).</p> Methods <p>This study enrolled patients who received a standard planning computed tomography (CT) scan before TAVR and dichotomized at the median of 33.31&#xa0;mm³/g of V/M ratio into groups with low V/M ratio and high V/M ratio. The V/M ratio was calculated by coronary computed tomography angiography (CTA). The endpoint was a composite of all-cause mortality, stroke, and hospitalization for heart failure. The cumulative incidence of the MACE was compared using Kaplan-Meyer plots and uni- and multivariate Cox proportional hazards regression analysis.</p> Results <p>In total, 139 patients were enrolled in this study finally (mean age 71.7 ± 6.7 years, 41.7% female). The mean V/M ratio was considerably lower in patients with MACE than in those without MACE (26.5 ± 4.9mm³/g vs. 34.0 ± 3.8mm³/g, <i>P</i>&lt;0.001). Multivariate Cox proportional hazards regression showed that the low V/M ratio group (≤ 33.31&#xa0;mm³/g) had a higher risk of MACE after TAVR (HR: 6.14, 95%CI: 1.37–27.54; <i>P</i> = 0.018).</p> Conclusions <p>The lower V/M ratio could serve as an independent predictor of MACE in patients undergoing TAVR.</p> Clinical trial number <p>Not applicable.</p>