To analyze the expression and clinical significance of serum retinol binding protein 4 (RBP4), superoxide dismutase (SOD) and hypersensitive C-reactive protein (hs-CRP) in patients with acute ST-segment elevated myocardial infarction (STEMI). Seventy-eight patients with STEMI who underwent percutaneous coronary intervention (PCI) admitted to Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2017 to March 2019 were enrolled. On the basis of the routine treatment, atorvastatin calcium or rosuvastatin calcium treatment was given. According to the results of coronary angiography, the patients were divided into three groups: single-vessel, double-vessel and three-vessel lesions, and the severity of coronary artery disease score (SYNTAX score) was performed. The serum RBP4, SOD and hs-CRP were measured and compared among different groups before and after treatment. The correlation between the three serum parameters of STEMI patients and the SYNTAX score, risk prediction (STEMI high-risk score) and prognosis were recorded and compared among different groups. There was no significant difference in serum RBP4, SOD and hs-CRP among different groups before treatment. In multivessel (double-vessel and three-vessel) vascular disease group, SYNTAX score was significantly correlated with RBP4 and hs-CRP (double-vessel lesions: r values were 0.616 and 0.489 respectively, three-vessel lesions: r values were 0.423 and 0.357 respectively, all P < 0.05), but had no correlation with SOD (r values were 0.108 and 0.055 respectively, both P > 0.05), and high-risk score was closely correlated with RBP4 and hs-CRP levels (r values were 0.581 and 0.623 respectively, both P < 0.01). There was no significant difference in the prognosis of patients treated with different statins. There were 8 and 7 high-risk patients in the atorvastatin calcium group and rosuvastatin calcium group, respectively, and 2 and 3 dead patients respectively (both P > 0.05). Combined detection of serum RBP4, SOD and hs-CRP levels can be used as better indicators to predict the risk of STEMI, which is worthy of clinical application.