Background: A novel inflammation-related biomarker, the monocyte to high-density lipoprotein cholesterol ratio (MHR), had a great relation to the development and prognosis of coronary atherosclerotic heart disease. Current study was to investigate whether the MHR was a potential tool in predicting the mortality and major adverse cardiac events (MACEs) in patients suffering coronary heart disease (CHD) by meta-analysis.Methods: The Cochrane Library, PubMed, MEDLINE, Scopus, EMBASE, and Web of science were searched for relevant cohort studies published prior to February 10, 2022. The association between MHR and mortality/MACEs was analyzed in patients with CHD. Hazard ratios (HR) with 95% confidence interval (CI) were calculated to estimate the strength of association.Results: In the meta-analysis, a total of 9 studies of 11,345 patients with CHD were included. Compared with the low level of MHR group, the high MHR value was associated with higher long-term MACEs (HR = 1.72 95% CI 1.36-2.18, P < .001), long-term mortality (HR = 1.71, 95% CI 1.10-2.66, P = .017), and in-hospital mortality/MACEs (HR = 2.82, 95% CI = 1.07-7.41, P = .036).Conclusions: This study suggested that increased MHR value might be associated with higher long-term mortality and longterm MACEs in CHD patients. MHR might serve as a potential prognostic indicator for risk stratification in patients with CHD.Abbreviations: CAD = coronary artery disease, CHD = coronary heart disease, CI = confidence interval, HDL = High-density lipoprotein, HDL-C = HDL-cholesterol, HR = Hazard ratios, MACEs = major adverse cardiac events, MHR = monocyte to highdensity lipoprotein cholesterol ratio, NOS = New Castle-Ottawa scale, PRISMA = preferred reporting items for systematic reviews and meta-analyses, STEMI = ST-segment elevation myocardial infarction.