Mediation analysis further indicated that MMP-9 partially mediated the association between SPP1 and plaque vulnerability, accounting for 44.2% of the total effect.<h4>Conclusion</h4>Elevated serum SPP1 levels are independently associated with imaging-defined plaque vulnerability and short-term cardiovascular events in patients with coronary artery disease. This evidence concerns the gene SPP1 and coronary artery disorder.