Aim To analyze the influencing factors of adverse cardiovascular events in elderly patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish a nomogram prediction model. Methods A total of 216 elderly patients with acute STEMI who underwent PCI in Jinqiu Hospital of Liaoning Province from February 2021 to January 2023 were selected and divided into occurrence group (n＝33) and non-occurrence group (n＝183) according to the occurrence of postoperative adverse cardiovascular events. General data, laboratory indicators, imaging information, and postoperative medication data of all patients were collected.Univariate and multivariate Logistic regression analysis were used to explore independent risk factors for adverse cardiovascular events. A nomogram prediction model was constructed according to independent risk factors of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein/albumin ratio (CAR), C-reactive protein to high density lipoprotein cholesterol ratio (CHR), calibration curve was drawn to verify the nomogram model, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of the predictive model for column line diagrams. Results The levels of NLR, PLR, CAR, CHR, Gensini score, and platelet aggregation ratio (PAR) were significantly higher in occurrence group than those in non-occurrence group, left ventricular ejection fraction(LVEF) was significantly lower in occurrence group (P＜0.05). Logistic regression analysis showed that Gensini score, LVEF, PAR, NLR, PLR, CAR and CHR were independent risk factors for adverse cardiovascular events after PCI in elderly acute STEMI patients (P＜0.05). The column-line diagram model for predicting the risk of adverse cardiac events after PCI in elderly acute STEMI patients was constructed based on independent risk factors, and the calibration curve of the model was close to the ideal model, and the ROC curve showed that the area under the ROC curve for the prediction of the risk of adverse cardiovascular events in the elderly acute STEMI patients was 0.914. Conclusion NLR, PLR, CAR and CHR are independent risk factors for adverse cardiovascular events in elderly acute STEMI patients after PCI, and the nomogram model constructed based on these factors can effectively predict the risk of adverse cardiovascular events in elderly acute STEMI patients after PCI.