Predictive Value of Naples Prognostic Score for 30-Day Mortality and MACE in Patients Undergoing TAVI for Severe Aortic Stenosis

Objective: Transcatheter aortic valve implantation (TAVI) has revolutionized treatment of severe aortic stenosis, yet early mortality risk stratification remains challenging. The Naples Prognostic Score (NPS), integrating inflammatory and nutritional markers, has shown promise in cardiovascular disease prognosis. This study investigated the relationship between preprocedural NPS and 30-day mortality in TAVI patients.
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 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: Mean age was 79.81±7.68 years with 54.9% female patients. High NPS group comprised 191 patients (62.0%) versus 117 patients (38.0%) in low NPS group. Thirty-day mortality was significantly higher in high NPS patients (16.8% vs 4.3%, p<0.001), representing nearly four-fold increased risk. NPS demonstrated good discriminative ability for mortality prediction (AUC 0.692, 95% CI 0.611-0.774, p<0.001), performing comparably to established surgical risk scores. Independent predictors of mortality included age (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: NPS serves as a significant predictor of early mortality following TAVI, offering a simple, readily available tool for preoperative risk stratification. High NPS patients may benefit from enhanced perioperative monitoring and targeted interventions.

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