Abstract： Objective To investigate the predictive value of plasma eicosanoids in predicting adverse cardiovascular events in patients with acute coronary syndromes(ACS).Methods Totally 309 hospitalized patients with ACS were retrospective analyzed,admitted to Beijing Anzhen Hospital,Capital Medical University for revascularization treatment from June to December 2019,with a median follow-up time of 3.8(3.6,3.9)years.Patients were divided into event group(33 cases)and non-event group(276 cases)based on the occurrence of adverse cardiovascular events.High performance liquid chromatography tandem mass spectrometry was used to determine 74 types of patient's plasma eicosanoids levels,and patient's global registry of acute coronary events risk(GRACE)score was performed.Differential eicosanoids were screened out in the two groups,patients were divided into different groups according to the cut-off of plasma eicosanoids from receiver operating characteristic(ROC)curve analysis.The effects of eicosanoids on the prognosis of ACS patients were evaluated by multivariate Cox regression analysis and Kaplan-Meier plots,and the value of eicosanoids and GRACE score in predicting adverse cardiovascular events was analyzed by ROC curve.Results The plasma 15-hydroxyeicosatetraenoic acid(15-HETE),15-oxoeicosatetraenoic acid(15-oxo-ETE)and 14,15-dihydroxyeicosatrienoic acid(14,15-DHET)of patients in the event group were significantly higher than those in the non-event group(all P＜0.05).Cox regression analysis showed that after adjusting for multivariate factors,15-HETE≥0.84 μg/L and 14,15-DHET≥0.20 μg/L were independent risk factors for adverse cardiovascular events in ACS patients after revascularization(both P＜0.05).A Kaplan-Meier curve showed patients in 15-HETE≥0.84 μg/L and 14,15-DHET ≥0.20 μg/L,were more likely to experience adverse events(both Log-rank P＜0.01).The ROC curve analysis showed that the area under the curve predicted by GRACE score alone and 15-HETE,14,15-DHET and GRACE scores in combi-nation for adverse cardiovascular events in ACS patients after revascularization were 0.699 and 0.712 respectively.The area under the curve predicted by GRACE score combined with 15-HETE and 14,15-DHET was larger than that predicted by GRACE score alone(P＜0.05).Conclusions High levels of plasma 15-HETE and 14,15-DHET are independent risk factors for the risk of adverse cardiovascular events in patients with ACS after revascularization,and have certain predictive value for adverse cardiovascular events.