Abstract
BACKGROUND: Coronary artery disease (CAD) is a leading global health concern, with inflammation playing a pivotal role in its pathogenesis. The high-sensitivity C-reactive protein/albumin ratio (CAR) has emerged as a novel marker reflecting both systemic inflammation and physiological reserve. However, its predictive value in specific populations, particularly in the Southern Arab Peninsula, remains underexplored. OBJECTIVE: To evaluate the association of CAR in identifying CAD among Yemeni adults referred for coronary computed tomography angiography (CCTA), by assessing its association with coronary artery calcium (CAC) and CAD-RADS scores. METHODS: This cross-sectional study included 249 Yemeni patients with suspected CAD who underwent CCTA. High-sensitivity C-reactive protein and albumin levels were measured to calculate CAR. CAD severity was assessed using CAC and CAD-RADS scoring systems. Statistical analyses explored correlations and predictive performance. RESULTS: CAR demonstrated a significant positive correlation with CAC scores (r = 0.357, p < 0.001) and CAD-RADS levels (p < 0.001). ROC curve analysis yielded an AUC of 0.708, with an optimal CAR cut-off value of 0.0285, achieving 67.9% sensitivity and 63.6% specificity. Multivariable logistic regression confirmed CAR as an independent predictor of CAD (AOR = 11.28, p < 0.001), alongside diabetes, hypertension, dyslipidemia, and smoking. CONCLUSION: CAR is a promising, cost-effective inflammatory marker for early CAD risk stratification, especially in resource-limited settings. Its strong correlation with CAC and CAD-RADS supports its clinical utility in identifying high-risk individuals who may benefit from further cardiovascular evaluation.