Restricted accessResearch articleFirst published online 2024-9
Evaluation of Naples Score for Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
The Naples score (NS), which is a composite of cardiovascular adverse event predictors including neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, albumin, and total cholesterol, has emerged as a prognostic risk score in cancer patients. We aimed to investigate the predictive value of NS for long-term mortality in ST-segment elevation myocardial infarction patients (STEMI). A total of 1889 STEMI patients were enrolled in this study. The median duration of the study was 43 months (IQR: 32–78). Patients were divided into 2 groups according to NS as group 1 and group 2. We created 3 models as a baseline model, model 1 (baseline + NS in continuous), and model 2 (baseline + NS as categorical). Group 2 patients had higher long-term mortality rates than group 1 patients. The NS was independently associated with long-term mortality and adding NS to a baseline model improved the model performance for prediction and discrimination of long-term mortality. Decision curve analysis demonstrated that model 1 had a better net benefit probability for detecting mortality compared with the baseline model. NS had the highest contributive significant effect in the prediction model. An easily accessible and calculable NS might be used for risk stratification of long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention.
IbanezBJamesSAgewallS, et al.2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of cardiology (ESC). Eur Heart J. 2018;39:119-77.
2.
FoxKAADabbousOH, et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333:1091-4.
3.
HulsmansMHolvoetP. The vicious circle between oxidative stress and inflammation in atherosclerosis. J Cell Mol Med. 2010;14:70-8.
4.
WongBWMeredithALinDMcManusBM. The biological role of inflammation in atherosclerosis. Can J Cardiol. 2012;28:631-41.
5.
GaliziaGLietoEAuricchioA, et al.Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum. 2017;60:1273-84.
6.
SawantAAdhikariPNarraSSrivatsaSMillsPSrivatsaS. Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction. Cardiol J. 2014;21:500-8.
7.
BicciréFGPastoriDTanzilliA, et al.Low serum albumin levels and in-hospital outcomes in patients with ST segment elevation myocardial infarction. Nutr Metabol Cardiovasc Dis. 2021;31:2904-11.
8.
KirisTÇelikAVarişE, et al.Association of lymphocyte-to-monocyte ratio with the mortality in patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology. 2017;68:707-15.
9.
WangTYNewbyLKChenAY, et al.Hypercholesterolemia paradox in relation to mortality in acute coronary syndrome. Clin Cardiol2009; 32:E22-8.
10.
ThygesenKAlpertJSJaffeAS, et al.Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72:2231-64.
11.
GibsonCMCannonCPDaleyWL, et al.TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879-88.
12.
GibsonCMCannonCPMurphySA, et al.Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation. 2000;101:125-30.
13.
AkaikeH. A new look at the statistical model identification. IEEE Trans Automat Control. 1974;19:716-23.
14.
AhoKDerryberryDPetersonT. Model selection for ecologists: the worldviews of AIC and BIC. Ecology. 2014;95:631-6.
15.
SteyerbergEWVickersAJCookNR, et al.Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010;21:128-38.
16.
BurnhamKPAndersonDR. Practical use of the information-theoretic approach. In: BurnhamKPAndersonDR (eds) Model selection and inference: a practical information-theoretic approach. New York, NY: Springer New York; 1998. pp. 75-117.
17.
HallerPMJägerBFarhanS, et al.Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network. Wien Klin Wochenschr. 2018;130:172-81.
18.
TakagiKTanakaAYoshiokaN, et al.In-hospital mortality among consecutive patients with ST-Elevation myocardial infarction in modern primary percutaneous intervention era ∼ insights from 15-year data of single-center hospital-based registry. PLoS One. 2021;16:e0252503.
19.
BessonovISKuznetsovVAZiryanovIPSapozhnikovSSPotolinskayaYV. [Impact of diabetes mellitus and blood glucose levels on the results of treatment of patients with ST-elevation myocardial infarction undergoing percutaneous coronary interventions]. Kardiologiia. 2019;59:16-22.
20.
KızıltunçEŞahinYBTopalS, et al.Effects of smoking on very-long term mortality after first ST elevation myocardial infarction. Arq Bras Cardiol. 2022;118:24-32.
21.
RossingtonJASolEMasouraK, et al.No-reflow phenomenon and comparison to the normal-flow population postprimary percutaneous coronary intervention for ST elevation myocardial infarction: case-control study (NORM PPCI). Open Heart. 2020;7:e001215.
22.
ZhangSWanZZhangY, et al.Neutrophil count improves the GRACE risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction. Atherosclerosis. 2015;241:723-8.
23.
KurtulAYarliogluesMMuratSN, et al.Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Am J Cardiol. 2014;114:342-7.
24.
AdamsteinNHMacFadyenJGRoseLM, et al.The neutrophil-lymphocyte ratio and incident atherosclerotic events: analyses from five contemporary randomized trials. Eur Heart J. 2021;42:896-903.
25.
van der LaanAMHirschARobbersLFHJ, et al.A proinflammatory monocyte response is associated with myocardial injury and impaired functional outcome in patients with ST-segment elevation myocardial infarction: monocytes and myocardial infarction. Am Heart J. 2012;163:57-65.
26.
ChojkierM. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol. 2005;39:143-6.
27.
PrajapatiKDSharmaSSRoyN. Current perspectives on potential role of albumin in neuroprotection. Rev Neurosci. 2011;22:355-63.
28.
MikhailidisDPGanotakisES. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7:125-37.
29.
ManolisAAManolisTAMelitaHMikhailidisDPManolisAS. Low serum albumin: a neglected predictor in patients with cardiovascular disease. Eur J Intern Med. 2022;102:24-39.
30.
NairDCarriganTPCurtinRJ, et al.Association of total cholesterol/high-density lipoprotein cholesterol ratio with proximal coronary atherosclerosis detected by multislice computed tomography. Prev Cardiol. 2009;12:19-26.
31.
BaeJ-MYangY-JLiZ-MAhnY-O. Low cholesterol is associated with mortality from cardiovascular diseases: a dynamic cohort study in Korean adults. Jkms. 2012;27:58-63.
32.
GnanenthiranSRNgACCCummingR, et al.Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins. Heart. 2020;106:698-705.
33.
RauchhausMClarkALDoehnerW, et al.The relationship between cholesterol and survival in patients with chronic heart failure. J Am Coll Cardiol. 2003;42:1933-40.
34.
AhmadAChuaNKhirR, et al.Impact of cholesterol levels on acute coronary syndrome mortality in north of Kuala Lumpur. Int J Cardiol. 2017;249:32-44.
35.
BeharSGraffEReicher-ReissH, et al.Low total cholesterol is associated with high total mortality in patients with coronary heart disease. The bezafibrate infarction prevention (BIP) study group. Eur Heart J. 1997;18:52-9.
36.
NagoNIshikawaSGotoTKayabaK. Low cholesterol is associated with mortality from stroke, heart disease, and cancer: the jichi medical school cohort study. J Epidemiol. 2011;21:67-74.
37.
LawMRThompsonSGWaldNJ. Assessing possible hazards of reducing serum cholesterol. BMJ. 1994;308:373-9.
38.
MiyamotoYHiyoshiYDaitokuN, et al.Naples prognostic score is a useful prognostic marker in patients with metastatic colorectal cancer. Dis Colon Rectum. 2019;62:1485-93.
39.
ErdoganAGencOOzkanE, et al.Impact of Naples prognostic score at admission on in-hospital and follow-up outcomes among patients with ST-segment elevation myocardial infarction. Angiology2023:000331972311515.
40.
SongSYZhaoXXRajahG, et al.Clinical significance of baseline neutrophil-to-lymphocyte ratio in patients with ischemic stroke or hemorrhagic stroke: an updated meta-analysis. Front Neurol. 2019;10:1032.
41.
WangQMaJJiangZWuFPingJMingL. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine (Baltim). 2017;96:e7897.
42.
DjousséLRothmanKJCupplesLALevyDEllisonRC. Serum albumin and risk of myocardial infarction and all-cause mortality in the framingham offspring study. Circulation. 2002;106:2919-24.
43.
SilvaNBettencourtPGuimarãesJT. The lymphocyte-to-monocyte ratio: an added value for death prediction in heart failure. Nutr Metabol Cardiovasc Dis. 2015;25:1033-40.
44.
GotsmanIShauerAZwasDRTahirogluILotanCKerenA. Low serum albumin: a significant predictor of reduced survival in patients with chronic heart failure. Clin Cardiol. 2019;42:365-72.
45.
Benites-ZapataVAHernandezAVNagarajanVCauthenCAStarlingRCTangWHW. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol. 2015;115:57-61.
46.
HorwichTBHamiltonMAMacLellanWRFonarowGC. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J Card Fail. 2002;8:216-24.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
