Objective: To investigate the relationship between serum lipoprotein(a) [Lp(a)], uric acid (UA) and γ-glutamyl transferase (GGT) with coronary artery lesions and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: 100 patients with acute STEMI undergoing PCI admitted to the Department of Internal Medicine-Cardiovascular of the Second Affiliated Hospital of Anhui Medical University from January 2019 to July 2022 were selected as the acute STEMI group. 56 patients were divided into the non-severe lesion group and 44 patients in the severe lesion group according to the Gensini score. The patients were followed up for 3 months after PCI and were divided into MACE subgroup and non-MACE subgroup according to whether MACE occurred. 50 patients with coronary angiography excluding coronary artery disease in the same period were also selected as the control group. Clinical data of patients with acute STEMI were collected, and serum Lp(a), UA, and GGT levels were detected. The correlation between serum Lp(a), UA, GGT levels and Gensini score in patients with acute STEMI and the influencing factors of MACE after PCI were analyzed. Results: Compared with control group, serum Lp(a), UA and GGT levels in the STEMI group were increased (P<0.05). The Lp(a), UA and GGT levels in the severe lesion group were higher than those in the non-severe lesion group (P<0.05). Spearman correlation coefficient analysis showed that serum Lp(a), UA, GGT levels were positively correlated with Gensini score in patients with acute STEMI (P<0.05). 3 months after follow-up, the incidence of MACE in 100 patients with acute STEMI after PCI was 21.00%(21/100). Multivariate Logistic regression analysis showed that the increased age, KILLIP cardiac function grade≥Ⅲ, elevated Lp (a), UA and GGT were independent risk factors for MACE after PCI, and the elevated left ventricular ejection fraction (LVEF) was independent protective factor (P<0.05). Conclusion: Elevated serum Lp(a), UA and GGT levels in patients with acute STEMI are closely correlated with the severity of coronary artery lesions and MACE after PCI, and may be the auxiliary predictors of MACE after PCI in acute STEMI patients. [ABSTRACT FROM AUTHOR]