Turk Kardiyol Dern Ars. Ahead of Print: TKDA-00255 | DOI: 10.5543/tkda.2026.00255
Association of the Naples Prognostic Score With the Presence and Severity of Isolated Coronary Artery Ectasia
Kadir Bıyıklı1, Sezer Markirt2, Barkın Kültürsay3, Sabri Abuş2, Erkan Markirt2, Deniz Merde Özdemir2, Fethi Yavuz4, Neşri Danışman1, Doğancan Çeneli1, Cemalettin Yılmaz51Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, Istanbul, Türkiye
2Department of Cardiology, University of Adıyaman Training and Research Hospital, Adıyaman, Türkiye
3Department of Cardiology, Tunceli State Hospital, Tunceli, Türkiye
4Department of Cardiology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Türkiye
5Department of Cardiology, Yalova Training and Research Hospital, Yalova, Türkiye
Objective: Coronary artery ectasia (CAE) is characterized by abnormal coronary dilation and is associated with chronic vascular inflammation. The Naples Prognostic Score (NPS), a composite marker reflecting inflammatory and nutritional status, has shown prognostic significance in cardiovascular disorders. However, its relationship with isolated CAE remains unclear.
Method: This retrospective case-control study included 95 patients with isolated CAE and 95 controls with normal coronary arteries who underwent elective coronary angiography between January 2021 and October 2024. The NPS was calculated using serum albumin, total cholesterol, the neutrophil-to-lymphocyte ratio, and the lymphocyte-to-monocyte ratio. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Additionally, CAE severity was assessed according to the Markis and Harikrishnan classifications.
Results: NPS values were significantly higher in patients with CAE than in controls (p=0.021), and an NPS ≥3 was more common in the CAE group (37.9% vs. 16.8%, p=0.002). In the multivariable analysis, NPS was independently associated with CAE both as a continuous variable (OR: 1.73, p=0.001) and as a binary variable (OR: 5.62, p<0.001). The estimated probability of CAE increased progressively with higher NPS values, from approximately 28% at a score of 0 to 77% at a score of 4. NPS values also differed significantly across the Markis classification subgroups (p=0.004), with higher values observed in patients with more extensive, diffuse (Type I) disease.
Conclusion: NPS is independently associated with the presence and angiographic distribution of isolated CAE. These findings suggest that the inflammatory and nutritional burden reflected by NPS may be associated with CAE and support its potential role, pending prospective validation, as a practical clinical marker in this population.
Keywords: Coronary angiography, coronary artery ectasia, inflammation, Naples Prognostic Score, nutritional status
Corresponding Author: Kadir Bıyıklı
Manuscript Language: English