Prognostic impact of Naples prognostic score on long-term mortality in non-ST-elevation myocardial infarction

The Naples Prognostic Score (NPS) is a composite index of inflammation and nutritional status. This study aimed to evaluate the prognostic value of NPS for long-term all-cause mortality in non-ST-elevation myocardial infarction (NSTEMI).

In this study, 396 consecutive NSTEMI patients who underwent coronary angiography/percutaneous coronary intervention between 1 August 2023, and 31 July 2024, were included. Patients were stratified into low (NPS: 0-1), intermediate (NPS: 2), and high (NPS: 3-4) risk groups. Median follow-up was 433 days. Univariate logistic regression identified predictors of longterm mortality. These were then entered into LASSOpenalized logistic regression for variable selection. Multivariate Cox proportional hazards models assessed the independent predictors of long-term mortality, adjusting for SYNTAX score, hemoglobin, sodium, age, and left ventricular ejection fraction (LVEF).

High-risk NPS patients (n = 91) had higher long-term mortality (17.6%) compared with intermediate-risk (3.7%) and low-risk (3.5%) groups (p < 0.001). In the adjusted Cox model, high-risk NPS independently predicted long-term mortality (HR:3.79; 95% CI 1.55-9.27; p = 0.003), whereas neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were not significant when substituted for NPS.

In NSTEMI patients, NPS independently predicts long-term all-cause mortality beyond traditional risk markers and outperforms isolated inflammatory indices such as NLR and CRP.