Predictive value of the Naples prognostic score for no-reflow phenomenon after saphenous vein graft stenting

Background No-reflow is a critical adverse event associated with percutaneous coronary intervention (PCI), particularly during saphenous vein graft (SVG) procedures. The Naples Prognostic Score (NPS) reflects inflammatory status, but its relationship with no-reflow remains unclear. Therefore, we aimed to evaluate the relationship between NPS and no-reflow occurrence following SVG PCI.Methods We retrospectively analyzed 286 patients who underwent SVG PCI from January 2020 to January 2024, with a median age of 65 years and 85.7% male. Participants were categorized into low NPS (0–2, 48.6%) and high NPS (3–4, 51.4%) groups. Two nested models were developed by adding NPS (continuous and categorical, respectively) to the base model.Results Higher no-reflow rates were noted in the high-NPS group (48.5% vs. 9.5%, p < 0.05). Multivariable regression revealed that a higher NPS significantly increased no-reflow risk, with odds ratios of 5.966 (95% CI: 3.066–11.611) for continuous NPS and 10.110 (95% CI: 3.194–32.002) for categorical NPS. Adding NPS to the base model significantly improved predictive performance (likelihood-ratio test p < 0.001). Model 1 demonstrated the best performance (X2 : 84.857, R2 : 0.468) and discriminative ability (AUC: 0.888).Conclusion Our findings suggest that NPS is a strong predictor of no-reflow following SVG PCI.