Objective：To investigate the relationship between the apoB/apoA1 ratio and the severity of coronary artery lesions and prognosis in patients with coronary heart disease（CHD）. Methods：A retrospective study was conducted in 512 hospitalized patients who were suspected CHD from 2014 to 2016. According to coronary angiography，all patients were divided into CHD group（n=381） and control group（n=131）. Gensini score（GS） was used to assess the severity of coronary artery lesions. The clinical features of the two groups were compared. The features of lipid indices in CHD group and its correlation with GS were analyzed. The incidence of the major adverse cardiovascular events（MACE） followed up for one year was also analyzed. Results：①The level of apoB/apoA1 0.65（0.53 to 0.83） in CHD group was significantly increased than the level of apoB/apoA1 0.53（0.41 to 0.67） in control group（P=0.000）. ②Only the apoB/ApoA1 ratio in lipid indices remained significantly associated with CHD according to binary logistic regression anal－ysis after multivariable adjustment（OR=46.810，P=0.000）. ③Area under the ROC curves of the apoB/apoA1 ratio for predicting CHD was 0.698（P=0.000），which was the highest among other lipid indices. ④The level of apoB/ApoA1 was continually rising with GS increased（P=0.000）. The apoB/apoA1 ratio showed the strongest correlation with GS among other lipid indices. ⑤The patients of CHD group with a higher level of apoB/apoA1（>0.65） had a higher incidence of MACE in 1 year（P=0.008）. Conclusion：The apoB/apoA1 ratio is an independent risk factor for predicting CHD，and it also has a close relationship with the severity of coronary artery lesions and prognosis for CHD.