What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=222). Intervention: High NAPLES prognostic score (NPS 3-4) vs. Low NAPLES prognostic score (NPS 0-2). Primary outcome: One-year mortality (HR 5.94, 95% CI 2.03-17.37, p=0.001).

January 2, 2025Kardiologia Polska9 citationsOpen Access

The performance of the NAPLES prognostic score in predicting one-year mortality and major adverse cardiovascular events after transcatheter aortic valve implantation in patients with severe aortic stenosis

MGMesut GitmezBatman University TGTuncay GüzelSağlık Bilimleri Üniversitesi MKMehmet KışInterventional / Structural Cardiology

Key Result

A high NAPLES prognostic score independently predicted a significantly increased risk of one-year mortality (HR 5.94) in patients with severe aortic stenosis undergoing TAVI.

Study Design

Type

Cohort (n=222)

Multicenter

Structured PICO

Does a high NAPLES prognostic score predict one-year mortality and MACEs in patients with severe aortic stenosis undergoing TAVI?

Population

222 older adults (mean age 79.2 years, 55.8% female) with severe aortic stenosis who underwent transfemoral transcatheter aortic valve implantation, followed for one year.

Exposure

High NAPLES prognostic score (NPS 3-4)

Comparator

Low NAPLES prognostic score (NPS 0-2)

Outcome

One-year mortality and major adverse cardiovascular events (MACEs)hard clinical

The NAPLES prognostic score, combining nutritional and inflammatory markers, is a strong independent predictor of one-year mortality and MACE in patients undergoing TAVI.

Main Result

Hazard Ratio: 5.94 (95% CI 2.03–17.37)

Absolute Event Rate: 23.7% vs 4.8%

p-value: p=0.001

Limitations

Retrospective design
Restricted patient sample size
Exclusion of patients with incomplete data may have affected results
Inability to establish correlation between NPS and other inflammatory markers and nutritional indices
Uncertainties related to dynamic changes in albumin levels and other blood parameters over time

Abstract

BACKGROUND: Existing risk scores for transcatheter aortic valve implantation (TAVI) may not fully capture patient complexity. Combining nutritional and inflammatory markers, the NPS (the NAPLES prognostic score) might improve outcome prediction. AIMS: This study investigated the associations of the NPS with one-year mortality and major adverse cardiovascular events (MACEs) in TAVI patients. MATERIAL AND METHODS: This retrospective analysis included 222 patients with severe aortic stenosis who underwent TAVI. The NPS was calculated based on the serum albümin concentration, cholesterol concentration, lymphocyte/monocyte ratio, and neutrophil/lymphocyte ratio. The patients were subsequently categorized into two groups: the low-NPS group (NPS 0-2) and the high-NPS group (NPS 3-4). RESULTS: A high NPS was significantly associated with increased one-year mortality (4.8% vs. 23.7%; P <0.001) and MACE rates (7.2% vs. 35.9%; P <0.001). Cox regression analysis demonstrated that a high NPS was an independent predictor of both mortality (HR, 5.94; 95% CI, 2.03-17.37; P = 0.001) and MACEs (HR, 5.09; 95% CI, 2.15-12.02; P <0.001). CONCLUSIONS: The NPS emerged as a potential predictor of long-term mortality and MACEs in TAVI patients. Further validation through larger, multicenter, studies is warranted. This research contributes valuable data on the role of the NPS in TAVI risk stratification.

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