Background Coronary artery disease (CAD) is a major global health issue, and its severity assessment via the C-reactive protein-to-albumin ratio (CAR) is cost-effective and simple. However, the correlation between the CAR and CAD severity in patients with myocardial infarction (Ml) remains understudied in less developed countries. Consequently, this study was designed to assess the correlation between CAR levels and the CAD severity among MI patients. Methods This study with a cross-sectional study design was carried out among 265 patients with Ml at Davao Medical School Foundation Hospital, Davao City, over one year (June 2023 to June 2024). Enrollment of the patients was performed via consecutive sampling based on established inclusion and exclusion criteria. A self-designed proforma was applied to gather data. Patients were categorized into non-severe (scores ≤50) and severe CAD (scores > 50) categories according to the Gensini scoring system. IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States) was used for data analysis. The comparative statistics were performed between non-severe and severe CAD groups using independent t-tests and chi-square tests. The association between the CAR and CAD severity was examined through Pearson's correlation analysis. Linear regression modeling was used to determine the predictive ability of CAR for CAD severity. Statistical significance was defined as a p-value < 0.05. Results Among 265 patients, 172 (64.90%) had non-severe CAD while 93 (35.10%) had severe CAD. Patients with severe CAD exhibited a markedly higher mean CAR (17.85 $ 15.21) compared to those with non-severe CAD (4.28 ‡ 2.16). Statistically significant differences were noted in Gensini scores (p=0.001) and CAR values (p=0.001) between the two study cohorts. A strong positive relationship was observed between CAR and the severity of CAD (r=0.78, 95% Cl=0.73 to 0.83, p < 0.001). Furthermore, regression model analysis confirmed the CAR as a notable determinant of the severity of CAD, with a 95% Cl of 1.75-4.96 (p < 0.001), positive values of unstandardized coefficient (3.23) and standardized coefficient (0.78), and an R-squared value of 0.84. Conclusions The present study presented a substantial positive correlation between the CAR and the severity of CAD among patients with Ml. An increased CAR was associated with higher CAD severity suggesting CAR's potential utility in clinical practice for identifying patients at high risk of CAD, enabling prompt intervention, and monitoring their response to treatment.

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