Relationship Between the Naples Prognostic Score and Saphenous Vein Graft Disease after Coronary Artery Bypass Grafting Surgery

Karaduman, Ahmet; Yılmaz, Cemalettin; Tiryaki, Muhammet Mucahit; Balaban, İsmail; Keten, Mustafa Ferhat; Unkun, Tuba; İzci, Servet; Efe, Suleyman Çağan; Alizade, Elnur

doi:10.36660/abc.20240519

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Original Article • Arq. Bras. Cardiol. 122 (5) • Apr 2025 • https://doi.org/10.36660/abc.20240519i linkcopy

Relationship Between the Naples Prognostic Score and Saphenous Vein Graft Disease after Coronary Artery Bypass Grafting Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Saphenous vein graft (SVG) patency remains a challenge in cases of coronary artery disease following coronary artery bypass grafting (CABG) surgery. The Naples prognostic score (NPS) constitutes a novel scoring system designed to assess both nutritional status and inflammation.

Objectives Our study aimed to explore the association between the NPS and SVG disease in patients with a previous history of CABG surgery.

Methods A total of 702 patients who had undergone CABG surgery and underwent coronary angiography were reviewed retrospectively. SVG disease was defined as the presence of ≥50% stenosis in at least one SVG. Patients were categorized into two groups based on the presence or absence of SVG disease. Values of p<0.05 were accepted as statistically significant.

Results The study population consisted of 702 patients, with 269 (38.3%) having degenerative SVGs and 433 (61.7%) without degenerative SVGs. The NPS was higher in the group with saphenous vein degeneration and emerged as a significant predictor of SVG disease (OR: 1.596, 95% CI: 1.198-2.125, p=0.001). Additionally, hypertension (OR: 2.344, 95% CI: 1.137-4.833, p=0.02), chronic kidney disease (OR: 3.337, 95% CI: 1.554-7.168, p=0.002), statin usage (OR: 0.434, 95% CI: 0.239-0.789, p=0.006), time interval since CABG (OR: 1.138, 95% CI: 1.213-1.432, p<0.001), and number of SVGs (OR: 2.708, 95% CI: 1.902-3.855, p<0.001) were significant predictors of SVG disease.

Conclusion The NPS, a useful tool for assessing inflammation and nutritional status, could provide valuable information about the patency of SVGs following CABG surgery. Patients with elevated NPS after CABG should undergo careful monitoring for the development of SVG disease.

Myocardial Revascularization; Saphenous Vein; Inflammation; Atherosclerosis

Central Illustration:
Relationship Between the Naples Prognostic Score and Saphenous Vein Graft Disease after Coronary Artery Bypass Grafting Surgery

Variables	SVG degeneration (+) n=269 (38.3%)	SVG degeneration (-) n=433 (61.7%)	p
Age (years)	66 (59-71)	65 (60-73)	0.782
Gender (male), n (%)	222 (82.5)	369 (85.2)	0.342
HT, n (%)	238 (89.5)	326 (75.3)	<0.001*
DM, n (%)	153 (56.9)	148 (34.2)	<0.001*
CKD, n (%)	64 (23.8)	56 (12.9)	<0.001*
SAP	84 (31.5)	251 (58)	<0.001*
STEMI	21 (7.8)	11 (2.6)	0.001*
Non-STEMI	164(61)	171(39.4)	<0.001*
Cerebrovascular disease, n (%)	31 (11.5)	24 (5.5)	0.004*
EF (%)	55 (40-65)	65 (55-65)	<0.001*
Atrial fibrillation, n (%)	39 (14.5)	33 (7.6)	0.004*
Time interval since CABG (year)	7 (5-9.25)	4 (2-6)	<0.001*
Number of SVGs	3 (2-3)	2 (2-3)	<0.001*
Acetylsalicylic acid usage, n (%)	250 (92.9)	413 (95.4)	0.169
Betablocker usage, n (%)	257 (95.5)	402 (93.5)	0.256
ACEi usage, n (%)	178 (66.7)	341 (78.8)	<0.001*
Oral anti-diabetic usage, n (%)	71 (26.8)	98 (22.6)	0.213
Insulin usage, n (%)	74 (27.8)	73 (16.9)	<0.001*
Statin usage, n (%)	185 (68.8)	360 (83.1)	<0.001*

Variables	SVG degeneration (+) n=269 (38.3%)	SVG degeneration (-) n=433 (61.7%)	p
WBC (10³/µL)	8.4 (5.9-10.5)	9.1 (6.9-11.6)	0.004*
Neutrophils	5.1 (3.8-7.1)	6.1 (3.8-7.4)	0.024*
Lymphocytes	1.3 (0.9-2.5)	2.1 (1.7-2.5)	<0.001*
Monocytes	0.7 (0.5-1)	0.7 (0.5-0.9)	0.278
Hemoglobin (g/dL)	13.4 (12.1-14)	13.7 (12.6-14.8)	<0.001*
Platelet count (10³/µL)	243 (194-271)	238 (190-281)	0.279
Total cholesterol (mg/dL)	187 (155-205)	189 (157.6-214.2)	0.872
Triglycerides (mg/dL)	137 (97-199)	145 (114-238)	0.012
HDL-C (mg/dL)	41 (37-48)	39 (37-49)	0.534
LDL-C (mg/dL)	107 (88-135)	104 (82-138)	0.309
eGFR (mL/min/1.73 m²)	64.9 (37.7-97)	77 (65.8-89)	<0.001*
Creatinine (mg/dL)	1.05 (0.86-1.97)	1 (0.89-1.160)	0.002*
Uric acid	6 (5.5-6.7)	5.7 (5.4-6.5)	0.913
Albumin (g/dL)	3.2 (3.-3.7)	3.9 (3.6-4.4)	<0.001*
CRP	15 (4-42.5)	10 (3-40)	0.004
NPS	3 (2-4)	2 (1-3)	<0.001*

Variables	Multivariate analysis
	p	OR	95% Confidence interval
	p	OR	Lower	Upper
Age (years)	0.227	0.983	0.956	1.011
Gender (male)	0.113	1.742	0.878	3.456
Hypertension	0.021	2.344	1.137	4.833
Diabetes mellitus	0.109	1.630	0.897	2.964
Cerebrovascular disease	0.394	0.670	0.267	1.683
Chronic kidney disease	0.002*	3.337	1.554	7.168
Atrial fibrillation	0.708	0.867	0.410	1.832
Ejection fraction	0.795	0.997	0.979	1.017
ACEi usage	0.110	0.604	0.326	1.121
Insulin usage	0.356	0.700	0.328	1.494
Statin usage	0.006*	0.434	0.239	0.789
Hemoglobin	0.058	0.827	0.679	1.006
Triglycerides	0.126	0.997	0.994	1.004
eGFR	0.697	0.998	0.989	1.008
CRP	0.171	1.005	0.998	1.011
NPS	0.001*	1.596	1.198	2.125
Time interval since CABG (years)	<0.001*	1.138	1.213	1.432
Number of SVGs	<0.001*	2.708	1.902	3.855

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[TFN1001] SVG: saphenous vein graft; HT: hypertension; DM: diabetes mellitus; CKD: chronic kidney disease; SAP: stable angina pectoris; STEMI: ST-elevation myocardial infarction; EF: ejection fraction; CABG: coronary artery bypass grafting surgery; ACEi: angiotensin-converting enzyme inhibitor.