Aim To investigate the predictive value of pulse pressure index (PPI) combined with arteriosclerosis index (AI) on coronary artery disease severity in patients with coronary heart disease (CHD). Methods A total of 150 patients who were diagnosed with CHD after coronary angiography (CAG) in Foshan Hospital of Traditional Chinese Medicine from January 2019 to October 2019 were selected and grouped into single-branch group (36 cases), double-branch group (49 cases), and three-branch group (65 cases); fifty patients without CHD after CAG recurrently were included in the control group. CHD classification:37 cases in stable angina pectoris (SAP) group, 42 cases in unstable angina pectoris (UAP) group, 35 cases in non-ST segment elevation myocardial infarction (NSTEMI) group, ST segment elevation myocardial infarction (STEMI) group of 36 cases. The differences in PPI and AI levels among each groups were compared, and the influencing factors of coronary artery disease severity in CHD patients were analyzed. The correlation between Gensini score and PPI and AI level was analyzed by Pearson analysis. The efficacy of PPI and AI in predicting coronary artery disease severity was analyzed by ROC curve. Results The levels of PPI and AI in the single-branch group, double-branch group, and three-branch group increased sequentially (P＜0.05). Compared with the SAP group, UAP group, NSTEMI group and STEMI group, there was no significant difference in PPI and AI levels (P＞0.05). Both PPI and AI were positively correlated with Gensini score (r＝0.561, r＝0.629, both P＝0.000). Multivariate Logistic regression showed that PPI and AI were the risk factors for CHD, and PPI, AI and Gensini score were the influencing factors of three-branch coronary artery disease (P＜0.05). The area under curve (AUC) of PPI and AI to predict CHD was 0.809 and 0.899, respectively, and the AUC of PPI combined with AI to predict CHD was 0.937. The AUC of PPI and AI for predicting three-branch coronary artery disease was 0.893 and 0.917, respectively, the PPI combined with AI had higher efficacy in predicting three-branch coronary artery disease, with an AUC of 0.969. Conclusion PPI and AI are closely related to severity of coronary artery disease in CHD patients. PPI combined with AI has high predictive value for coronary artery disease severity in CHD patients.