Abstract: Objective To develop a nomogram for evaluating the prognosis of patients with coronary artery borderline lesions guided by intravascular ultrasound (IVUS), based on coronary CT fractional flow reserve (CT-FFR). Methods A total of 264 patients with coronary artery borderline lesions, who underwent coronary CT angiography and IVUS (with an interval of less than two weeks) in Jiangyin People's Hospital were enrolled and their clinical data were collected for retrospective analysis. The patients were randomly divided into a training set and a validation set at a ratio of 7∶3. Independent risk factors were screened through Lasso regression and multivariate logistic regression analysis, which were then used to construct a prognostic nomogram. The nomogram was comprehensively evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA). Results Percutaneous coronary intervention, Gensini score, CT-FFR, alanine aminotransferase, and apolipoprotein A1 were independent risk factors for major adverse cardiovascular events (MACE) in patients with coronary artery borderline lesions (P<0.05). The AUC value for the training set was 0.795 (95%CI: 0.728-0.863), while the AUC value for the validation set was 0.697 (95% CI: 0.579-0.815). The Hosmer-Lemeshow goodness-of-fit test showed χ²=6.400, P=0.603, indicating good calibration. The DCA curves for both the training and validation sets demonstrated good clinical utility of the nomogram. Conclusions The CT-FFR-based prognostic nomogram provides clinicians with a personalized tool for evaluating the prognosis of patients with coronary artery borderline lesions guided by IVUS.