Aim To study the predictive value of serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) for cardiovascular adverse events after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods The patients diagnosed as acute STEMI receiving emergency PCI in our hospital from May 2017 to May 2019 were selected for retrospective study. Cardiovascular adverse events including death, myocardial infarction, ventricular arrhythmia and cerebrovascular accident were evaluated after PCI.Then the influencing factors for cardiovascular adverse events and the predictive value of serum sTWEAK were analyzed after PCI. Results Among the 100 patients, 14 patients had cardiovascular adverse events after PCI, and the incidence was 14%. Univariate analysis showed that compared with the patients without cardiovascular adverse events after PCI, the incidence of diabetes, white blood cell count, blood glucose, hypersensitive C-reactive protein, creatine kinase-MB (CK-MB) peak value, the proportion of multi vessel lesions and the content of sTWEAK increased, the time from the onset to PCI prolonged, the proportion of tirofiban use, the proportion of thrombus aspiration and TIMI grade after treatment decreased, in the patients with cardiovascular adverse events after PCI. Logistic regression analysis showed that diabetes mellitus, CK-MB peak value, sTWEAK, tirofiban use and thrombus aspiration were the influencing factors of cardiovascular adverse events after PCI. The best cut-off point of serum sTWEAK in predicting cardiovascular adverse events after PCI was 68.5 ng/L, and the sensitivity and specificity were 62.35% and 71.43% respectively. Conclusion The increase of serum sTWEAK in patients with acute STEMI at admission has a predictive value for cardiovascular adverse events in the hospital after PCI.