BackgroundThe prognostic value of the serum albumin-to-creatinine ratio (sACR) in patients with ST-elevation myocardial infarction (STEMI) remains unclear. This study aims to investigate the impact of the sACR on incident major adverse cardiovascular events (MACEs) among revascularized patients with STEMI at long-term follow-up.MethodsA total of 461 patients with STEMI who underwent successful primary percutaneous coronary intervention (PCI) were enrolled to explore the association between the sACR and MACE during a 30-month follow-up. The Cox regression proportional hazard model was used to evaluate the prognostic value of the sACR. Heterogeneity among specific groups was investigated by subgroup analysis.ResultsA total of 118 patients developed MACE during the follow-up. A negative association between the sACR and MACE was found after adjusting for other MACE-related risk factors. In subgroup analyses, the sACR was inversely associated with MACE in patients aged ≥ 60 years [hazard ratio (HR), 0.478; 95% confidence interval (CI), 0.292–0.784], male (HR, 0.528; 95% CI, 0.327–0.851), with hypertension history (HR, 0.470; 95% CI, 0.271–0.816), and with anterior wall myocardial infarction (HR, 0.418; 95% CI, 0.239–0.730). Meanwhile, the negative association between the sACR and MACE remained significant in a sensitivity analysis that excluded patients with low serum albumin levels (HR, 0.553; 95% CI, 0.356–0.860).ConclusionsPatients with STEMI who underwent successful PCI with a low sACR had a higher risk of developing MACE, indicating that the sACR could be used to identify patients with STEMI who are at high risk of developing MACE.