There are few generalizable patterns in ecology, with widespread observations and predictability. One possible generalizable pattern is the cumulative trophic theory, which consistently exhibits S-curves of cumulative biomass over trophic level (TL) for over 200 different marine ecosystems. But whether those cumulative biomass patterns persist in some of the more distinct marine ecosystems, coral reefs, is unclear. Coral reefs are unique among marine ecosystems, representing global biodiversity hotspots and providing crucial ecosystem services. They are subject to many pressures, including both global (e.g., climate and ocean changes, warming, acidification) and local (e.g., overexploitation/overfishing, increase in turbidity, bleaching, habitat destruction, invasive species) stressors. The analysis of emergent ecosystem features, such as cumulative biomass S-curves, could represent a useful and new analytical option that can also be implemented for coral reefs. The cumulative biomass approach was applied to 42 U.S. Pacific islands (Guam and the Commonwealth of Northern Mariana Islands, American Samoa, the Pacific Remote Islands Areas, and the Northwestern and Main Hawaiian Islands), using data collected from fish surveys. Results show that coral reef ecosystems do indeed follow the S-curve patterns expected from cumulative trophic theory, which is not trivial for tropical reef systems that tend to be less widely examined and strongly dominated by structuring organisms like corals. The curve parameters results are also consistent with both fish assemblage diversity indexes and the benthic substrate ratio, which suggests this measure could serve as a useful ecosystem indicator to measure the ecological status of reefs. Moreover, the curve shape was consistent with what one would expect for different levels of perturbation, with the areas more densely inhabited showing less pronounced S-curves, in contrast to those observed in low human population density islands. All this is reflected in the curve parameters, particularly inflection point of the TL and steepness, generally showing a negative response to both natural and anthropogenic disturbances. Cross-archipelago differences have also been detected with the Hawaiian Island chain tending to have lower inflection points for biomass and TL than other regions. Collectively our findings demonstrate the potential application of the cumulative biomass approach to evaluate coral reef ecosystems.