Both the conventional Naples score and CRP-modified Naples score were independently associated with in-hospital mortality and provided comparable prognostic performance in patients with NSTE-ACS undergoing PCI.
In-hospital mortality occurred in 8.6% of NSTE-ACS patients undergoing PCI in this study cohort.
Both the conventional Naples score and modified Naples score remained independently associated with in-hospital mortality after multivariable adjustment including GRACE score.
The AUC values for both scores in predicting in-hospital mortality were similar and did not differ statistically.
Addition of the conventional Naples score to the base model provided slightly better reclassification improvement than the modified Naples score.
Decision curve analysis showed positive net clinical benefit for both scores with no consistent superiority of either score.
Inflammation and nutritional status, as captured by Naples-based scores, are prognostically relevant in NSTE-ACS patients.
This research examined whether two scoring systems — the conventional Naples score and a modified version that incorporates C-reactive protein (CRP), a marker of inflammation — could predict which patients hospitalized with a type of heart attack called non-ST-elevation acute coronary syndrome (NSTE-ACS) were at risk of dying during their hospital stay. The study included 921 patients who underwent a procedure to open blocked coronary arteries (PCI), and 79 of them (about 1 in 12) died in the hospital. Both scores were higher in patients who died compared to those who survived, and both remained significant predictors of death even after accounting for other known risk factors including the established GRACE score. When comparing the two scores head-to-head, the researchers found they performed almost identically. The conventional Naples score had a slightly higher area under the curve (AUC of 0.683) than the modified score (AUC of 0.701), but this difference was not statistically meaningful. Both scores similarly improved risk prediction when added to standard clinical models, and decision curve analysis — which tests whether using a score would actually help clinicians make better treatment decisions — showed benefit for both without one being clearly superior. This research suggests that both Naples-based scores are useful, simple tools for identifying NSTE-ACS patients at higher risk of in-hospital death, and that replacing standard Naples score components with CRP does not meaningfully change predictive accuracy. Clinicians may find either version practical for early risk stratification alongside existing tools like the GRACE score, though the results come from a single center and retrospective design, which limits generalizability.
Cekici Y, Yildirim A, Pacaci E, Coskun M, Sezici E, Ozdemir H, et al.. (2026). Prognostic Value of Conventional and Modified Naples Scores for In-Hospital Mortality in Patients with Non-ST-Elevation Acute Coronary Syndrome.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62081573