The Naples Prognostic Score as a Predictive Tool for Saphenous Vein Graft Disease in Post-coronary Artery Bypass Grafting Patients

Abstract

Background and Aim: Coronary artery bypass grafting (CABG) remains the gold standard for managing complex coronary artery disease. However, saphenous vein graft disease (SVGD) significantly undermines long-term graft patency, with up to 50% of grafts failing within 10 years. Chronic inflammation, oxidative stress, and nutritional deficiencies are central to SVGD pathophysiology, underscoring the need for comprehensive predictive tools. This study evaluates the Naples Prognostic Score (NPS), a composite index of inflammatory and nutritional markers, as a predictor of SVGD. Materials and Methods: A retrospective analysis was conducted on 514 patients who underwent CABG and follow-up angiography between 2019 and 2022. Patients were categorized into SVGD (n=252) and the control (n=197) groups based on significant stenosis (≥50%) in at least one saphenous vein graft. NPS was calculated using albumin levels, lymphocyte-monocyte ratio, neutrophil-lymphocyte ratio, and cholesterol parameters. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate NPS as an independent predictor of SVGD. Results: The SVGD group demonstrated significantly higher rates of diabetes (59.4% vs. 49.2%, p=0.033), smoking (41.2% vs. 29.3%, p=0.011), and chronic kidney disease (27% vs. 17.8%, p=0.021). NPS stratification revealed a higher prevalence of high-risk patients (NPS Group 3: 42.5% vs. 29.6%, p=0.052) in the SVGD cohort. Multivariate regression identified smoking [Odds ratios (OR)=3.02, p=0.001], graft age (OR=1.07, p=0.011), albumin levels (OR=0.91, p<0.001), and NPS (OR=1.27, p=0.023) as independent predictors of SVGD. ROC analysis demonstrated strong predictive accuracy for NPS, supporting its clinical applicability. Conclusion: NPS is a robust, independent predictor of SVGD, integrating systemic inflammatory and nutritional parameters to enhance risk stratification. Its adoption in clinical workflows may guide targeted therapeutic interventions and improve graft patency outcomes. Further prospective studies are warranted to validate its utility across diverse populations and optimize long-term CABG success. © 2025 Elsevier B.V., All rights reserved.