Objective To investigate the value of ischemic J wave electrocardiogram combined with serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and soluble growth stimulation expressed gene 2 protein (ST2) on evaluating the prognosis of patients with acute myocardial infarction (AMI). Methods 152 patients with AMI in The Second Affiliated Hospital of Xi'an Medical College from October 2022 to October 2023 were selected and divided into MACE group (n=45) and non-MACE group (n=107) according to whether major adverse cardiovascular events (MACE) occurred. The detection rate of ischemic J wave and levels of serum NT-ProBNP and ST2 levels were compared between MACE group and non-MACE group. The ischemic J wave, NT-ProBNP and ST2 were used as independent variables, and the presence or absence of MACE was the dependent variable(occurrence=1, non-occurrence=0), thus multivariate Logistic regression model was established and the predictive probability of MACE by regression model was calculated. The predictive probability was used as a continuous variable to draw the receiver operating characteristic curve (ROC) to evaluate the predictive efficacy of the model on MACE. Results The detection rate of ischemic J wave and levels of serum NT-ProBNP and ST2 in MACE group were higher than those in non-MACE group (P<0.05). The levels of serum NT-ProBNP and ST2 in patients with ischemic J wave were higher than those in patients without ischemic J wave (P<0.05). Multivariate Logistic regression analysis showed that ischemic J wave, NT-ProBNP and ST2 were independent predictors of MACE (P<0.05). ROC curve suggested that the AUC of the combined prediction model was 0.872 (95%CI: 0.812-0.933).Conclusion The combined application of ischemic J wave, NT-ProBNP and ST2 levels can effectively predict the risk of MACE in patients with AMI, and has important value for clinical prognosis evaluation