Objective: To explore the predictive value of neutrophil-to-albumin ratio (NPAR) on the prognosis of patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). Methods: A retrospective analysis was performed on the clinical data of 506 NSTEMI patients admitted between January 2018 and October 2024. The general information, laboratory test results, and prognosis of the two groups were compared. The NPAR value was calculated, and patients were divided into high, medium, and low NPAR groups based on tertiles. Multivariable Cox regression analysis was used to investigate the relationship between NPAR and prognosis, and ROC curves were plotted to evaluate the predictive performance of NPAR. Results: The incidence of major adverse cardiovascular events (cardiac function) was significantly higher in the high NPAR group than in the medium and low NPAR groups (P < 0.05). Multivariable Cox regression analysis showed that significant changes in NPAR in the high NPAR group were important predictors of prognosis for NSTEMI patients. The results of this study indicate that significant changes in NPAR values in the high NPAR group are associated with mortality. Conclusion: NPAR serves as a significant prognostic predictor in NSTEMI patients. Elevated NPAR levels are strongly associated with increased mortality risk, supporting its utility in early risk stratification and clinical decision-making.