Elevated Uric Acid/Albumin Ratio Predicts Poor Coronary Collateral Circulation in Type 2 Diabetic Patients With Stable Coronary Artery Disease

Background The uric acid/albumin ratio (UAR) has been shown to correlate with coronary disease severity and clinical outcome. This study investigated the predictive value of UAR on coronary collateralization (CC) in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease. Methods Serum levels of uric acid and albumin were determined and UAR was calculated in 1558 T2DM patients with chronic total occlusion of at least one major coronary artery. The degree of collaterals supplying to the distal occluded bed from the contra‐lateral vessel was graded by Rentrop scoring system. Results Serum uric acid decreased and albumin increased gradually across Rentrop score 0 to 3, resulting in a higher UAR in patients with poor collaterals (Rentrop score 0 or 1) compared to those with good collaterals (Rentrop score 2 or 3) (9.74 [8.53–11.95] vs. 7.74 [6.61–8.84], p < 0.001). After adjusting for various confounders, elevated UAR was an independent factor for poor CC (adjusted OR 1.887, 95% CI 1.746–2.040, p < 0.001). UAR provided a better prediction for poor CC than uric acid and albumin alone (AUC 0.803 vs. 0.715 and 0.652; all p < 0.001). There existed an interaction between UAR and eGFR ( p = 0.016); high UAR being associated with a greater risk (OR 2.253 vs. 1.776) and having a better predictive ability for poor CC (AUC 0.830 vs. 0.786; p = 0.041) in patients with eGFR ≥ 90 mL/min/1.73 m 2 compared to those with eGFR < 90 mL/min/1.73 m 2 . Conclusions Elevated UAR predicts poor coronary collateral circulation in T2DM patients with stable coronary disease especially when renal function is preserved. These findings may help physicians better identify high‐risk patients and guide individualized management strategies. Trial Registration ClinicalTrials.gov identifier: NCT06054126