Response to Commentary on the Prognostic Value of the Naples Prognostic Score After PCI in Acute Coronary Syndrome

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Acute coronary syndrome (ACS). Intervention: High Naples Prognostic Score (NPS 3-4) vs. Low Naples Prognostic Score (NPS 0-2). Primary outcome: All-cause mortality and no-reflow.

Mustafa Bilal Özbay; Yasin Özen; Bülent Özbay

doi:10.1002/clc.70485

October 1, 2026Clinical CardiologyOpen Access

Response to Commentary on the Prognostic Value of the Naples Prognostic Score After PCI in Acute Coronary Syndrome

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Key result

High Naples Prognostic Score is linked to increased mortality and no-reflow after PCI for ACS.

Key Points

To address methodological commentary and clarify the utility and limitations of the Naples Prognostic Score (NPS) for risk stratification in acute coronary syndrome patients undergoing percutaneous coronary intervention.
The authors responded to commentary regarding their study-level meta-analysis of previously published observational studies evaluating the predefined categorical NPS framework (0–2 vs. 3–4).
Assessed aggregate data limitations including dichotomization of continuous biomarkers (serum albumin, total cholesterol, NLR, and LMR) without individual patient data.
Pooled meta-analysis data demonstrated consistent associations between high NPS and adverse outcomes, specifically all-cause mortality and no-reflow, despite inter-study variability.
The authors emphasized that NPS acts as an associative composite risk tool combining nutritional and systemic inflammatory status rather than a mechanistic or causal classifier.

PICO

P

Population

Acute coronary syndrome (ACS)

E

Exposure / Comparator

High Naples Prognostic Score (NPS 3-4) vs Low Naples Prognostic Score (NPS 0-2)

O

Primary Outcome

All-cause mortality and no-reflow

Limitations

Individual patient data were not available to permit continuous biomarker modeling.
Observational data cannot establish causality between the prognostic score and outcomes.
The composite score may encompass heterogeneous biological phenotypes.
Findings require prospective validation and calibration.

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Implication

Supports NPS as an associative risk marker in ACS-PCI; leaves open incremental value over existing scores in prospective validation.

Abstract

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Cite This Study

Özbay et al. (2026) conducted a letter in Acute coronary syndrome (ACS). High Naples Prognostic Score (NPS 3-4) vs. Low Naples Prognostic Score (NPS 0-2) was evaluated on All-cause mortality and no-reflow. A high categorical Naples Prognostic Score is consistently associated with adverse outcomes including all-cause mortality and no-reflow in acute coronary syndrome patients undergoing percutaneous coronary intervention.

synapsesocial.com/papers/6acb115f22e5745bb069e242 https://doi.org/10.1002/clc.70485

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Response to Commentary on the Prognostic Value of the Naples Prognostic Score After PCI in Acute Coronary Syndrome

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Response to Commentary on the Prognostic Value of the Naples Prognostic Score After PCI in Acute Coronary Syndrome

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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