The study aimed to determine whether high sensitivity C-reactive protein to 
prealbumin (hs-CRP/PAB) ratio could be used to predict in-hospital major adverse 
cardiac events (MACE) in patients with acute coronary syndrome (ACS). A total of 
659 patients with ACS were included in the study. Patients were divided into two 
groups: high hs-CRP/PAB ratio group (hs-CRP/PAB ≥0.010) and low hs-CRP/PAB ratio 
group (hs-CRP/PAB <0.010). MACE was defined as death, cardiogenic shock, 
re-infarction and acute heart failure. Logistic regression was performed and the 
receiver operating characteristic curve (ROC) was generated to evaluate the 
correlation of hs-CRP/PAB ratio and MACE in patients with ACS. The occurrence 
rate of MACE was significantly higher in high hs-CRP/PAB ratio group when 
compared with that in low hs-CRP/PAB ratio group (P < 0.001). Multivariable 
analysis determined that hs-CRP/PAB ratio was an independent predictor of MACE 
(adjusted odds ratio: 1.276, 95% confidence interval: 1.106-1.471, P = 0.001). 
Moreover, the area under the curve value of hs-CRP/PAB ratio for predicting MACE 
was higher than hs-CRP and equal to PAB. High hs-CRP/PAB ratio was considered as 
a prognostic parameter of MACE in ACS patients, with the predictive power equal 
to PAB but greater than hs-CRP.