摘要BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,pr-ognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to devel-op and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese pati-ents with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent pe-rcutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten varia-bles was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the rece-iver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agree-ment between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly high-er MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrim-mination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.