The Naples Prognostic Score as a Predictor of High-Risk Coronary Plaques Detected on Coronary CT Angiography in Chronic Coronary Syndrome

<b>Background/Objectives:</b> High-risk coronary plaques (HRP), identified through coronary CT angiography (CCTA), are closely linked to cardiovascular events. Nutritional status and systemic inflammation may play a critical role in the development of HRP. The Naples Prognostic Score (NPS), which integrates markers of nutritional status and systemic inflammation, has emerged as a potential predictor of outcomes in various cardiovascular conditions. This study aimed to investigate the association between NPS and HRP as assessed by CCTA. <b>Methods:</b> A retrospective analysis was performed on 753 patients with chronic coronary syndrome (CCS) who underwent CCTA. The patients were categorized into two groups: those with high-risk plaques (HRP present), and those without (HRP absent). Additionally, they were further stratified based on their NPS. Univariable and multivariable logistic regression analyses were conducted to identify the most relevant clinical factors and the role of NPS in relation to HRP and the need for revascularization. <b>Results:</b> The study population had a mean age of 56.9 ± 10.7 years, with 40% being female. The NPS was significantly higher in the HRP-present group compared to the HRP-absent group (<i>p</i> = 0.001). Stratification by NPS groups revealed that higher NPS groups were associated with increased coronary artery calcification scores (CAC) and revascularization rates (<i>p</i> < 0.001 and <i>p</i> = 0.003, respectively). Multivariable regression analysis demonstrated a significant association between NPS and HRP (OR = 1.228, 95% CI: 1.013-1.489, <i>p</i> = 0.036). <b>Conclusions:</b> The NPS is independently associated with the presence of high-risk coronary plaques in patients with chronic coronary syndrome. NPS may serve as a complementary risk stratification tool by reflecting systemic inflammation and nutritional status. Further prospective studies are needed to validate its prognostic value.