Higher Neutrophil-to-Albumin Ratio Is Associated with Greater Coronary Atherosclerotic Burden According to the Gensini Score in an Angiography-Referred Population

<b>Objective:</b> This study aimed to investigate the association between the neutrophil-to-albumin ratio (NAR) and coronary atherosclerotic burden, assessed using the Gensini score, in patients referred for coronary angiography (CAG). <b>Methods:</b> A total of 987 patients who underwent CAG at Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2020 and June 2023 were retrospectively analyzed. Demographic, clinical, and laboratory data, including complete blood count, albumin, lipid profile, and creatinine, were collected prior to angiography. The NAR was calculated as the ratio of absolute neutrophil count to serum albumin. Coronary atherosclerotic burden was assessed using the Gensini scoring system and analyzed across predefined score categories representing increasing anatomical disease extent: normal (score 0), mild (1-24), and severe (≥25). Statistical analyses included group comparisons and multivariable regression analyses appropriate to the study design. <b>Results:</b> Higher NAR values were associated with increased angiographic coronary atherosclerosis severity at the group level across Gensini score categories. This association remained statistically significant after prespecified multivariable adjustment for established cardiovascular risk factors. <b>Conclusions:</b> Higher NAR values were associated with greater angiographic coronary atherosclerotic burden, as quantified by the Gensini score, in an angiography-referred population.