Association between Uric Acid-to-Albumin Ratio and Angiographic Coronary Artery Disease Burden among Patients Undergoing Coronary Angiography in Somalia

Abstract The uric acid-to-albumin ratio (UAR) has emerged as a marker of oxidative stress and inflammation, but its relationship with angiographic coronary artery disease (CAD) burden remains insufficiently studied in African populations. This study evaluated the association between UAR and angiographic CAD burden among patients undergoing coronary angiography in Somalia. This retrospective observational study included 387 adult patients who underwent coronary angiography at Somalia's largest percutaneous coronary intervention (PCI) center between June 2022 and March 2024. UAR was calculated from admission uric acid and albumin values. Outcomes included obstructive CAD, multivessel CAD, three-vessel CAD, left main involvement, and revascularization strategy. Logistic regression was used to assess associations between UAR and angiographic outcomes. The median age was 60 years, and 75.5% were male. Obstructive CAD was present in 65.9%, multivessel CAD in 34.4%, three-vessel CAD in 13.2%, and left main involvement in 7.8%. Patients with multivessel CAD had significantly higher UAR than those without multivessel CAD (1.67 vs. 1.53; p = 0.006). Multivessel CAD increased numerically across UAR tertiles, but this did not reach statistical significance. In unadjusted regression, UAR was associated with multivessel CAD; however, this association was attenuated after adjustment for age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, and acute coronary syndrome presentation. UAR showed a modest unadjusted association with angiographic CAD burden, particularly multivessel CAD, but it was not independently associated after adjustment. UAR may reflect overall cardiometabolic and atherosclerotic burden, but should not be used as a stand-alone marker of angiographic CAD severity.