Prognostic Value of the Uric Acid-to-Albumin Ratio in Patients Undergoing Successful Percutaneous Coronary Intervention for Chronic Total Occlusion

Introduction: The uric acid-to-albumin ratio (UAR) is a novel cardiovascular biomarker, but its prognostic value in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains unknown. Materials and Methods: This retrospective study enrolled 1513 consecutive patients who underwent successful CTO-PCI at a single center from February 2011 to December 2023. Patients were stratified by baseline UAR tertiles. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), and the secondary endpoint was all-cause mortality. Multivariable Cox regression and restricted cubic spline (RCS) analyses were performed. Results: During a median follow-up of 810 days, patients in the highest UAR tertile had significantly higher rates of MACCE (18.5%, 10.1%, and 7.5% across tertiles; p < 0.001) and all-cause mortality (10.7%, 3.8%, and 2.0%; p < 0.001). After multivariable adjustment, each one-unit increase in UAR was associated with a 6% higher risk of MACCE (HR 1.06; 95% CI 1.02–1.10; p = 0.002) and a 9% higher risk of all-cause mortality (HR 1.09; 95% CI 1.04–1.14; p < 0.001). Patients in the highest UAR tertile had significantly increased risks of MACCE (HR 1.90; 95% CI 1.25–2.90; p = 0.003) and all-cause mortality (HR 3.40; 95% CI 1.62–7.12; p = 0.001) compared with those in the lowest UAR tertile. RCS analysis showed significant overall associations between UAR and both MACCE and all-cause mortality, with no significant evidence of nonlinearity. Conclusions: Elevated baseline UAR was independently associated with long-term MACCE and all-cause mortality after successful CTO-PCI. These findings support UAR as a readily available prognostic marker but do not establish causality or support UAR-guided therapeutic decision-making. Prospective studies are needed for validation.