Heart failure (HF) is a terminal stage of cardiovascular diseases, classified based on ejection fraction. Serum uric acid (SUA) has been implicated in the pathogenesis and progression of coronary artery disease (CAD) with HF, yet its predictive value remains unclear. This study aimed to evaluate the predictive role of SUA in the progression of HF in CAD patients and its potential to differentiate HF types. A retrospective analysis was conducted on 342 CAD patients, including 29 with CAD alone and 313 with CAD complicated by varied HF types. Biochemical parameters and HF severity were assessed, and logistic regression analyses were performed to identify independent predictors of HF progression. Significant differences were observed in biochemical parameters, including glutamic-pyruvic transaminase (ALT), glutamic oxalacetic transaminase (AST), alkaline phosphatase (ALP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), creatine kinase-MB (CK-MB), SUA, lactate dehydrogenase (LDH), myoglobin (MTO), between groups. SUA levels were significantly higher in CAD patients with HF, particularly in those with reduced ejection fraction. Univariate and multivariate logistic regression analyses identified history of hypertension, AST, and SUA as independent predictors of HF progression, with SUA showing the highest odds ratio. In addition, SUA levels were positively correlated with Gensini scores, indicating its association with CAD severity. SUA is a strong predictor of HF progression in CAD patients, especially for patients with HFrEF, which can serve as a diagnostic and prognostic marker for HF progression in CAD patients.