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Background Monocyte to high density lipoprotein ratio (MHR) has been considered as a novel parameter related with adverse renal and cardiovascular outcomes.In this study we investigated the association of MHR with major adverse clinical events (MACEs) in patients with type 2 diabetes mellitus (T2DM) undergoing elective percutaneous coronary intervention (PCI).Methods Consecutive T2DM patients treated with elective PCI were prospectively recruited between July 2008-January 2016 in Department of Cardiology of Panyu Central Hospital.Subjects were categorized into two groups:as patients who developed MACEs (MACEs+) and patients who did not develop MACEs (MACEs-) during hospitalization.MACEs were defined as the composite end points,including all-cause mortality,or acute heart failure,or target vessel revascularization,or stroke or recurrent angina.Results A total of 418 patients were included in the study.64 patients developed MACEs (15.3％).In the MAC-Es (+) patients,monocytes were higher (1.12 [0.78-1.42] vs.0.72 [0.68-0.92] 109/L,P ＜ 0.01) and HDL cholesterol levels were lower (0.87 [0.72-1.21] vs.0.96 [0.81-1.11] mmol/L,P ＜ 0.01).In addition,MHR was significantly higher in the MACEs (+) group (1.12 [0.91-2.09] vs.0.73[0.54-0.93] 109 mmol/L,P ＜ 0.01).The cutoff value of MHR for predicting MACEs was 22,with a sensitivity of 81％ and a specificity of 75.1％ (area under the curve 0.79,P ＜ 0.001).In multivariate logistic regression analysis,MHR remained an independent factor correlated with MACEs (OR =3.97,95％CI =1.38-11.5,P ＜ 0.01).Conclusion Higher MHR levels may predict MACEs development after elective PCI in T2DM patients.