Uric Acid to HDL-C Ratio as a Marker of Coronary Artery Disease Severity in Non-ST-Elevation Myocardial Infarction Patients.

Background: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has been associated with both the functional and anatomical significance of coronary lesions. This study aimed to investigate the relationship between UHR and the severity of coronary artery disease (CAD) in patients with non-ST-elevation myocardial infarction (NSTEMI), as evaluated using the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score. Methods: This retrospective study analyzed data from 606 NSTEMI patients who underwent coronary angiography between April and December 2024. UHR was calculated by dividing serum uric acid by high-density lipoprotein cholesterol. Patients were classified into low (SYNTAX < 23) and intermediate-high severity (SYNTAX ≥ 23) groups and compared in terms of parameters including UHR. Results: UHR showed a significant positive correlation with SYNTAX score (ρ = 0.417, p < 0.001) and emerged as an independent predictor of intermediate-high severity CAD (odds ratio: 1.069, p < 0.001). Receiver operating characteristic curve analysis yielded an area under the curve of 0.705, with a UHR cut-off of > 20.35 predicting intermediate-high severity with 49.5% sensitivity and 85.4% specificity. Left ventricular ejection fraction also independently predicted CAD severity. Conclusions: UHR is an easily measurable, cost-effective biomarker for assessing CAD severity in NSTEMI patients. Its integration into clinical practice may improve early risk stratification and management strategies.