Subgroup analysis revealed that Hcy/HDL-C was more predictive in patients with large-artery atherosclerosis (LAA), while hs-CRP/Alb showed stronger prognostic value in patients with cardioembolic strokes.<h4>Conclusion</h4>The Hcy/HDL-C and hs-CRP/Alb ratios serve as independent and valuable biomarkers for predicting poor outcomes in ACI patients post-rt-PA treatment. The gene discussed is ALB; the disease is cardioembolic stroke.