Objective To investigate the value of plasma proprotein convertase subtilisin/kexin type 9(PCSK9) combined with von Willebrand factor (VWF) levels in predicting development of major adverse cardiovascular events (MACE ) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 164 STEMI patients selected as STEMI group, and were divided into the mild stenosis group(n=49), moderate stenosis group (n=75) and severe stenosis group (n=40)according to the Gensini score, and another 67 physically healthy patients during the same period were selected as the control group. Plasma PCSK9 and VWF levels were measured by ELISA, and the correlations between plasma PCSK9 and VWF levels and Gensini score in STEMI patients were analyzed by Spearman. Factors influencing the development of MACE in STEMI patients were analyzed by multi-factor Logistic regression. The ROC curve was used to analyze the predictive value of plasma PCSK9 and VWF levels in the development of MACE in STEMI patients. Results Compared with the control group, the plasma PCSK9 and VWF levels increased in the STEMI group (t/Z=-9. 019, 9. 410, all P<0. 01). Plasma PCSK9 and VWF levels increased in the mild stenosis, moderate stenosis and severe stenosis groups in that order(F/H=71. 981, 69. 905, all P<0. 01). Plasma PCSK9 and VWF levels were positively correlated with Gensini scores in STEMI patients(r=0. 578, 0. 614, all P<0. 01). At 6 months of follow-up, the incidence of MACE in 164 STEMI patients was 19. 51%(32/164). Time from onset to consultation(OR=1. 636, 95% CI: 1. 180 to 2. 270, P<0. 05), low-density lipoprotein cholesterol(OR=1. 076, 95% CI:1. 032 to 1. 122, P<0. 05), Gensini score(OR=1. 849, 95% CI:1. 208 to 2. 831, P<0. 05), PCSK9(OR=1. 037, 95% CI:1. 010 to 1. 064, P<0. 05), and VWF(OR=1. 012, 95% CI:1. 004 to 1. 020, P<0. 05)were independent risk factors for the development of MACE, and left ventricular ejection fraction(OR=0. 835, 95% CI:0. 737 to 0. 947, P<0. 05)was an independent protective factor for the development of MACE. The area under the curve(AUC)of PCSK9, VWF, and PCSK9 + VWF in predicting MACE in STEMI patients was 0. 781, 0. 795, and 0. 863, respectively, and the AUC of PCSK9 + VWF in predicting MACE in STEMI patients was greater than that of PCSK9 and VWF alone(Z=2. 434, 2. 110, both P<0. 05). Conclusion Plasma PCSK9 and VWF levels increase in STEMI patients, which are closely associated with the degree of coronary stenosis and can be used as the predictors of the development of MACE in STEMI patients. [ABSTRACT FROM AUTHOR]