Introduction

Carotid artery stenting (CAS) is an established revascularization strategy, particularly in high-risk surgical patients. The uric acid-to-albumin ratio (UAR) has recently emerged as a novel composite biomarker reflecting oxidative stress, systemic inflammation, and nutritional status.

Aim

This study evaluated the prognostic significance of UAR in predicting mid-term all-cause mortality following CAS.

Material and methods

In this retrospective cohort study, 970 consecutive patients undergoing CAS at a tertiary cardiovascular center between 2015 and 2024 were analyzed. The primary endpoint was mid-term all-cause mortality. Patients were stratified into Low UAR (< 1.475) and High UAR (≥ 1.475) groups based on the median UAR. Survival analyses were performed using Cox proportional hazards models to identify independent predictors of all-cause mortality.

Results

The median follow-up was 33.7 ±26.5 months. Overall, 154 (15.9%) patients died, with mortality significantly higher in the High UAR group compared with the Low UAR group (19.0% (n = 92) vs. 12.8% (n = 62); p = 0.008). In multivariable Cox regression analysis, neutrophil count (HR = 1.09, 95% CI: 1.00–1.19, p = 0.038) and UAR (HR = 1.69, 95% CI: 1.24–2.31, p = 0.001) were identified as independent predictors of mid-term all-cause mortality.

Conclusions

Elevated UAR was independently associated with increased all-cause mortality after carotid artery stenting. UAR may serve as a simple and readily available marker reflecting overall systemic risk; however, further studies are needed to confirm its clinical utility.