Abstract: Objective To investigate the influencing factors of heart failure (HF) in elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), and the prediative value of serum copeptin, soluble grouth stimulation gene 2 (sST2), and neutrophil gelatinase-associated lipocalin (NGAL). Methods A total of 400 elderly AMI patients treated with PCI at the 970th Hospital of the Joint Logistics Support Force of the People’s Liberation Army from January 2022 to November 2025 were enrolled. These patients were grouped based on the occurrence of postoperative early in-hospital heart failure (HF): those who developed HF were assigned to the HF group, while the remaining patients were included in the non-HF group. The general demographic data, laboratory test results, and imaging findings were collected and compared between the two groups. Univariate and multivariate logistic regression analysis were used to investigate the influencing factors of HF. The predictive value of serum copeptin, sST2, and NGAL expression levels for the occurrence of HF post-PCI in elderly patients with AMI was evaluated through receiver operating characteristic (ROC) curve analysis. Results A total of 62 patients (15.50%) developed HF. The HF group exhibited higher age, higher proportion of patients with a Clinical Fatigue Scale (CFS) score ≥5, longer time from onset to hospital admission, higher coronary stenosis severity (Gensini score), and higher levels of preoperative N-terminal brain natriuretic peptide precursor (NT-proBNP), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), copeptin, sST2, and NGAL compared to the non-HF group, while having a lower level of left ventricular ejection fraction (LVEF) (P<0.01). Logistic regression analysis revealed that age, time from onset to hospital admission, Gensini score, NT-proBNP, copeptin, sST2, and NGAL were independent risk factors for post-PCI HF in elderly AMI patients, whereas LVEF was a protective factor (P<0.05). ROC curve analysis demonstrated that serum levels of copeptin, sST2, and NGAL could effectively predict the risk of post-PCI HF in elderly AMI patients, with combined prediction showing higher AUC and sensitivity (P<0.05). Conclusions The development of HF in elderly patients with AMI after PCI is influenced by multiple pathophysiological mechanisms. Serum copeptin, sST2, and NGAL serve as significant independent risk factors with high predictive value, and their combined use offers enhanced prognostic potential.

Key words: aged, acute myocardial infarction, percutaneous coronary intervention, heart failure, copeptin, soluble growth stimulation gene 2, neutrophil gelatinase-associated lipocalin