No previous meta-analysis has evaluated the relationship between pulmonary artery enlargement (PAE) measured by computed tomography (CT) and prognosis for patients with chronic obstructive pulmonary disease (COPD). Recently, several studies have suggested poor survival and reduced exercise capacity in COPD patients with PAE on CT scan, but there were conflicting results. We aimed to assess the prognostic value of PAE-CT in patients with COPD. Relevant studies were identified by searching major databases. Pooled outcomes were determined to assess the prognostic value of PAE-CT in COPD patients. Eighteen studies including 5694 participants were included. PAE indicated higher mortality in COPD patients (odds ratio [OR] = 3.06; 95% confidence interval [95% CI]: 1.76–5.32; p < 0.0001), shorter 6-minute walk distance (mean difference [MD] = −67.53 m; 95% CI: −85.98 to −49.08; p < 0.00001), higher pulmonary artery systolic pressure (MD = 15.65 mmHg; 95% CI: 13.20–18.11; p < 0.00001), longer length of hospital stay (MD = 2.92 days; 95% CI: 0.71–5.12; p = 0.009) and more severe symptom such as dyspnea (COPD Assessment Test MD = 3.14; 95% CI: 2.48–3.81; p < 0.00001). We also conducted a subgroup analysis regarding the lung function and blood gas analysis for a stable period and acute exacerbation of COPD patients. In conclusion, PAE is significantly associated with mortality, lower exercise tolerance, and poor quality of life in patients with COPD. PAE may serve as a novel imaging biomarker for risk stratification in patients with COPD in the future.