Objective: To explore the relationship between serum lipoprotein (a) levels and acute myocardial infarction (AMI) and aortic dissection in athletic patients and those with optimal physical health. Methods: This study involved 216 athletic patients admitted to a Chinese hospital for AMI who underwent Percutaneous Coronary Intervention (PCI) between 2018 and 2019. These patients, characterized by their athletic background and optimal physical health, were divided based on their serum lipoprotein (a) levels: 133 in the low-lipoprotein (a) group (<300 mg/L) and 83 in the high-lipoprotein (a) group (≥300 mg/L). Data including baseline demographics, laboratory tests, and details of interventional treatment were collected from medical records. All patients were followed up for two years post-discharge to record Major Adverse Cardiac Events (MACE). Factors influencing MACE were analyzed using univariate and multivariate logistic regression. Results: The low lipoprotein (a) group exhibited lower age, reduced Killip grades III-IV, lower LDL-C levels, and fewer diseased vessels than the high lipoprotein (a) group (P><0.05). The incidence of MACE was significantly lower in the low lipoprotein (a) group (5.3%, 7/133) compared to the high lipoprotein (a) group (27.87%, 51/183) (P><0.05). Univariate analysis identified significant differences in age, post-surgery β-blocker use, LDL-C levels, serum lipoprotein (a) levels, revascularization strategies, and the> <3 00 mg/L) and 83 in the high-lipoprotein (a) group (≥300 mg/L). Data including baseline demographics, laboratory tests, and details of interventional treatment were collected from medical records. All patients were followed up for two years post-discharge to record Major Adverse Cardiac Events (MACE). Factors influencing MACE were analyzed using univariate and multivariate logistic regression. Results: The low lipoprotein (a) group exhibited lower age, reduced Killip grades III-IV, lower LDL-C levels, and fewer diseased vessels than the high lipoprotein (a) group (P<0.05). The incidence of MACE was significantly lower in the low lipoprotein (a) group (5.3%, 7/133) compared to the high lipoprotein (a) group (27.87%, 51/183) (P><0.05). Univariate analysis identified significant differences in age, post-surgery β-blocker use, LDL-C levels, serum lipoprotein (a) levels, revascularization strategies, and the> <0.05). The incidence of MACE was significantly lower in the low lipoprotein (a) group (5.3%, 7/133) compared to the high lipoprotein (a) group (27.87%, 51/183) (P<0.05). Univariate analysis identified significant differences in age, post-surgery β-blocker use, LDL-C levels, serum lipoprotein (a) levels, revascularization strategies, and the number of diseased vessels (P<0.05). Multivariate analysis revealed serum lipoprotein(a) as an independent predictor of MACE in athletic patients post[1]PCI (OR=1.010, 95%CI: 1.007-1.013, P=0.000). Conclusion: Serum lipoprotein (a) levels are significantly associated with the incidence and progression of AMI and aortic dissection in athletic patients and those with optimal physical health. Athletic patients with low pre-PCI lipoprotein (a) levels had a reduced risk of MACE during the two-year follow-up. This suggests that serum lipoprotein (a) could be a valuable prognostic marker for these patients, aiding in the prediction and management of post-PCI outcomes.