ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity, mortality, and long-term disability worldwide. Primary percutaneous coronary intervention (PPCI) is the recommended reperfusion strategy for STEMI patients, as it effectively reduces myocardial necrosis and improves clinical outcomes [1]. However, even with timely reperfusion, the risk of adverse cardiac remodeling and the progression to heart failure cannot be entirely eliminated [2]. Currently available biomarkers, which primarily reflect myocardial injury, often lack the sensitivity and specificity to predict major adverse cardiovascular events (MACEs) or to effectively stratify high-risk patients [3,4]. This underscores the need to identify novel prognostic biomarkers that better reflect the underlying pathophysiological processes and enable early identification of patients at increased risk for poor outcomes.

Autoimmune mechanisms are increasingly recognized as important contributors to the pathogenesis of various cardiovascular diseases. In particular, autoantibodies targeting G protein-coupled receptors (GPCRs)-including β1-, β2-, and α1-adrenergic receptor autoantibodies (β1-, β2-, and α1-AAs), angiotensin II type 1 receptor autoantibodies (AT1-AAs), and M2-muscarinic receptor autoantibodies (M2-AAs) -have been implicated in the development and progression of heart failure, arrhythmias, and other cardiovascular conditions [5,6]. GPCRs are key mediators of extracellular signal transduction, and their dysregulation through autoantibody-mediated interference can lead to metabolic disturbances, cardiomyocyte apoptosis, pathological remodeling, and impaired autophagy [7].

Despite growing evidence of the pathogenic roles of GPCR-AAs in cardiovascular disease [8,9], their prognostic significance in STEMI patients following PPCI remains unclear. Therefore, this study aimed to investigate the association between serum levels of five GPCR-AAs at admission and the incidence of MACEs during a one-year follow-up in patients with STEMI undergoing PPCI.