This study explored the impact of thigh fat and muscle shape features on major adverse cardiovascular events (MACE) in elderly hip fracture patients. Using AVIEW Research software, cross-sectional area (CSA) and compactness (CM) of thigh fat and muscle were analyzed from CT images of 356 patients aged 65 and older who underwent hip fracture surgery. The primary outcome was MACE within 30 days post-surgery. Results indicated that lower fat area (FA) and fat compactness (FCM) were significantly associated with increased MACE risk. Specifically, patients with low FA and low FCM had a higher risk of MACE. In multivariate Cox regression analysis, low FA (<240.1 cm²) and low FCM (<0.477) were strong predictors of MACE. The study concludes that CT-derived measures of FA and FCM provide valuable prognostic information for predicting adverse cardiovascular outcomes in elderly hip fracture patients.