Naples prognostic score shows potential complementary value to agatston scoring in patients with very high coronary calcium burden: A single-center hypothesis-generating study.

Agatston score showed moderate accuracy and NPS showed limited performance for predicting obstructive CAD in the overall cohort.

• Study population: 426 stable angina patients undergoing coronary CT angiography and invasive angiography at İzmir City Hospital in 2024
• Mean age 61.7 ± 9.5 years, 63.4% male
• 277 patients (65.0%) had obstructive coronary artery disease
• Agatston score AUC = 0.644 (moderate accuracy)
• NPS AUC = 0.554 (limited performance)

In the subgroup of patients with very high coronary calcium burden (Agatston ≥1000), NPS achieved improved discriminatory performance and the combined model further improved AUC.

• Agatston ≥1000 subgroup included n = 43 patients
• NPS achieved AUC 0.680 in this subgroup
• Combined model (Agatston + NPS) achieved AUC 0.725 in this subgroup
• NPS was an independent predictor with OR 1.22 (P = .006)

Obstructive CAD patients had significantly different metabolic profiles compared to non-obstructive CAD patients.

• Obstructive CAD patients showed lower HDL (P = .005)
• Obstructive CAD patients had higher glucose levels (P = .008)
• Obstructive CAD patients had elevated HbA1c (P < .001)
• Authors concluded metabolic markers (HDL, glucose, HbA1c) are more discriminative than inflammatory markers for obstructive CAD

The correlation between Agatston score and NPS was negligible, suggesting they capture distinct pathophysiologic domains.

• Spearman correlation coefficient ρ = 0.048 between Agatston score and NPS
• Authors interpreted this as indicating that NPS captures distinct pathophysiologic domains not reflected by Agatston scoring
• This negligible correlation supports the potential complementary rather than redundant value of combining the two scores

The Agatston score shows limited specificity for obstructive coronary artery disease in patients with extensive calcification.

• This limitation motivated evaluation of NPS as a complementary tool
• NPS integrates inflammatory and nutritional parameters
• The study was designed as a retrospective, single-center, hypothesis-generating study
• Obstructive CAD was defined as significant lesions on coronary CT angiography and invasive angiography