To investigate the relationship between serum kallikrein 1 (KLK1) and SRY-box transcription factor 6 (SOX6) levels and major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI).A total of 150 STEMI patients who underwent PCI from October 2021 to October 2022 were included in this study. Patients were divided into MACE and Non-MACE groups based on the occurrence of postoperative adverse cardiovascular events. General data, laboratory findings, and imaging results were compared between the two groups. Logistic regression analysis was used to identify factors influencing MACE, which were further used to develop a joint prediction model. ROC curves were plotted to assess the predictive values of the model.MACE occurred in 20 patients (13.33%). The MACE group had significantly higher Killip grade (P = 0.020), elevated serum levels of cardiac troponin I (cTnI) (P = 0.040), creatine kinase (CK) (P = 0.044), KLK1 (P < 0.001), creatine kinase isoenzyme (CK-MB) (P = 0.043), and SOX6 (P < 0.001), as well as higher Gensini score (P = 0.040) and Grace score (P = 0.045). Logistic regression analysis identified KLK1 (OR = 1.015, P = 0.016) and SOX6 (OR = 1.823, P < 0.001) as independent risk factors for MACE. The combination of KLK1 and SOX6 showed excellent predictive value for MACE, with an AUC of 0.889.Elevated levels of KLK1 and SOX6 are associated with an increased risk of MACE. The combined detection of these biomarkers can effectively predict MACE, aiding in early identification and timely intervention for high-risk patients.AJTR Copyright © 2025.