摘要BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-Ⅳ database and categorized into qu-artiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute ki-dney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models ass-essed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7％)died in the hospital and 1944 patients(23％)died at 1 year.The incidence of AKI and RRT was 63％ and 4.3％,respectively.High AAR was markedly associated with in-hospital mor-tality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P＜0.001),AKI incidence(HR=1.579,P＜0.001),and RRT(HR=1.640,P＜0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substa-ntial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations bet-ween AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortal-ity,and adverse renal prognosis in critical CAD patients.