El Niño Southern Oscillation (ENSO) events modulate oceanographic processes that control temperature and productivity in tropical waters, yet potential interactions with low frequency climate variability, such as the Pacific Decadal Oscillation (PDO), are poorly understood. We show that ENSO and PDO together predicted (i) maximum sea-surface temperatures (SST), which were associated with coral bleaching and declines in coral cover, and (ii) maximum chlorophyll-a concentrations, which were associated with high densities of coral-predatory Acanthaster starfish, across the tropical north Pacific Ocean since 1980. Asynchrony between the positive PDO and negative ENSO (i.e., La Niña) was associated with peaks in annual SST. By contrast, synchrony between the positive PDO and positive ENSO (i.e., El Niño) was associated with peaks in chlorophyll-a. Both conditions led to ecological disturbances and significant loss of coral cover, however, spatial models revealed where impacts to reefs were expected under varying climate scenarios. The 2015/17 ENSO event was coupled with a positive PDO and resulted in high SST and Acanthaster abundances in eastern Micronesia, while positive coral growth occurred in western Micronesia. Our novel approach for forecasting coral growth into the future may be applicable to other oceanic regions with differing oceanographic modulators.