Predictive Value of the Naples Prognostic Score for 30-Day Mortality and Major Adverse Cardiovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis-Uncorrected Proof

Objective: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis; however, early mortality risk stratification remains challenging. The Naples Prognostic Score (NPS), which integrates inflammatory and nutritional markers, has shown promise in cardiovascular disease prognosis. This study investigated the relationship between preprocedural NPS and 30-day mortality in patients undergoing TAVI.

Method: This retrospective, single-center study analyzed 308 patients aged ≥ 65 years who underwent elective transfemoral TAVI between August 2012 and December 2022. NPS was calculated using the neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, serum albumin, and total cholesterol levels. Patients were stratified into low NPS (0-2) and high NPS (3-4) groups. The primary endpoint was 30-day all-cause mortality.

Results: The mean age was 79.81 ± 7.68 years, and 54.9% patients were female. The high NPS group comprised 191 patients (62.0%), while 117 patients (38.0%) were in the low NPS group. Thirty-day mortality was significantly higher in patients with high NPS (16.8% vs. 4.3%, P < 0.001), representing nearly a four-fold increased risk. NPS demonstrated good discriminative ability for mortality prediction (area under the curve: 0.692, 95% confidence interval: 0.611-0.774, P < 0.001), performing comparably to established surgical risk scores. Independent predictors of mortality included age (odds ratio [OR] 1.067, P = 0.039), neutrophil-to-lymphocyte ratio (OR 1.062, P = 0.048), and pulmonary artery pressure (OR 1.039, P = 0.006).

Conclusion: The Naples Prognostic Score is a significant predictor of early mortality following TAVI and offers a simple, readily available tool for preoperative risk stratification. Patients with high NPS may benefit from enhanced perioperative monitoring and targeted interventions.

Keywords: Mortality, Naples prognostic score, risk stratification, transcatheter aortic valve implantation