Objective:To correlate multiphase CT angiography (mCTA), serum lipid peroxidation (LPO) and thrombus precursor protein (TpP) levels with recurrence of acute cerebral infarction (ACI) in older adults and investigate the value of these indicators in the predication of ACI recurrence.Methods:A total of 128 older adult patients with ACI who received treatment in Ningbo Medical Center Lihuili Hospital, China between January 2019 and January 2020 were included in this study. All of them were followed up for 1 year. They were divided into ACI recurrence group ( n = 29) and no ACI recurrence group ( n = 99) according to whether they had recurrent cerebral infarction. All patients underwent mCTA. Maas system and Tan score were used according to mCTA images. Serum TpP level was measured using enzyme-linked immunosorbent assay. Serum LPO level was measured using Yagi's fluorescence method. Multiple linear regression analysis was used for correlation analysis. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of mCTA and serum LPO and TpP levels in the diagnosis of ACI. Results:Tan score in the ACI recurrence group was significantly lower than that in the no ACI recurrence group [(1.06 ± 0.26) points vs. (1.89 ± 0.82) points, t = 5.35, P < 0.05]. Serum TpP and LPO levels in the ACI recurrence group were (7.22 ± 1.35) mmol/L and (11.23 ± 2.58) nmol/mL, respectively, which were significantly higher than those in the no ACI recurrence group [(3.06 ± 0.28) mmol/L, (7.23 ± 0.37) nmol/mL, t = 28.86, 15.04, both P < 0.001]. ACI recurrence in older adult patients was correlated with Tan score and serum LPO and TpP levels (both P < 0.05). The sensitivity of mCTA combined with serum LPO and TpP levels in the diagnosis of ACI in older adults was 93.10%-96.60% and its specificity was 100.00%. The ROC curve analysis showed that the area under the ROC of mCTA, LPO and TpP in the prediction of ACI recurrence in older adults was 0.986 (95% CI = 0.966-1.000), 0.976 (95% CI = 0.930-1.000) and 0.968 (95% CI = 0.905-1.000), respectively. Conclusion:ACI recurrence in older adults is correlated with Tan score and serum LPO and TpP levels. mCTA, Tan score, and serum LPO and TpP levels have high sensitivity and specificity in the diagnosis of ACI recurrence in older adults, and therefore have a high diagnostic value.