Comparative Performance of the C-reactive Protein-to-Albumin Ratio (CAR) and the Thrombolysis in Myocardial Infarction (TIMI) Score in Predicting Major Adverse Cardiac Events (MACE) Among Patients With ST-Elevation Myocardial Infarction (STEMI)

Background Acute coronary syndrome (ACS) is a common emergency presentation. The C-reactive protein-to-albumin ratio (CAR) serves as a composite marker reflecting both systemic inflammation and nutritional status and may enhance prognostic accuracy in myocardial infarction (MI). Objective To assess the prognostic utility of the CAR in predicting disease severity and major adverse cardiac events (MACE) among patients with ST-elevation myocardial infarction (STEMI). Methodology A cross-sectional, observational, prospective study was conducted on 203 patients with STEMI who presented to the outpatient and emergency departments between November 2023 and May 2025. Demographic and clinical data were collected. Thrombolysis in myocardial infarction (TIMI) scores were calculated, and serum C-reactive protein and albumin levels were measured within 24 hours of admission. The primary outcome was in-hospital mortality, while MACE, including reinfarction, revascularization, heart failure, and death, was assessed at 28 days through follow-up. Results Among the participants, the in-hospital mortality rate was 14 (6.9%), and the 28-day incidence of MACE was 38 (18.7%). Notably, MACE occurred more frequently in patients with elevated CAR, even among those with lower TIMI scores, suggesting that CAR may be a more sensitive early predictor of adverse outcomes. CAR demonstrated superior prognostic performance, with an area under the curve (AUC) of 0.726 compared with 0.668 for the TIMI score. Conclusions A CAR threshold greater than 0.568 was identified as clinically useful for early risk stratification in patients with STEMI. These findings support the integration of CAR into routine assessments to improve early prognostic evaluation and guide clinical decision-making.