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<bold>Background:</bold> It has been reported that cardiovascular events (CVE) increase in the year following a Chronic Obstructive Pulmonary Disease exacerbation (E-COPD). In COPD, an increase in the pulmonary artery diameter/aortic diameter (PA/A) ratio on chest computed tomography (CT) is associated with pulmonary hypertension and exacerbation frequency, but its association with CVE is unknown. The present study aims to examine the association between the PA/A ratio and subsequent CVE. <bold>Methods:</bold> A single-centre retrospective cohort study was conducted for patients who had been admitted to our hospital for E-COPD between January 2018 and December 2022. Patient data, including chest CT on admission, were extracted from the medical records. The optimal cut-off value for the PA/A ratio to predict CVE after 1 year of E-COPD was determined from the receiver operating characteristic (ROC) curve, and the log-rank test was performed to compare the frequency of cardiovascular events between the high and low PA/A groups. <bold>Results:</bold> The final analysis included 235 patients. CVE occurred in 9.79 % of cases within 1 year. The area under the ROC curve based on the PA/A ratio was 0.639, and the optimal cut-off value was 1.042. The log-rank test showed that the high PA/A ratio group had significantly more CVE than the low PA/A ratio group (HR 2.946, 95% CI 1.247–6.958). Tricuspid regurgitation pressure gradient in echocardiogram conducted during hospitalization were not different significantly between the two groups. <bold>Conclusion:</bold> In patients with COPD, the PA/A ratio on chest CT is suggested to be predictive of post-exacerbation CVE.