1227 Available online at www.medicinescience.org ORIGINAL ARTICLE Medicine Science 2023;12(4):1227-31 Corresponding Author: Mustafa Oguz, Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye Email: drmustafaoguz@hotmail.com Modified naples prognostic score as a potential predictor for coronary slow flow: a retrospective observational study Mustafa Oguz 1 , Selami Dogan 2 , Mert Babaoglu 1 , Irem Yilmaz 1 , Sahhan Kilic 1 , Almina Erdem 1 , Akin Torun 1 , Mehmet Seker 1 , Mehmet Uzun 1 , Ahmet Lutfullah Orhan 1 1 Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, İstanbul, Türkiye 2 Malkara State Hospital, Department of Cardiology, Tekirdağ, Türkiye Received 04 September 2023; Accepted 01 October 2023 Available online 19.10.2023 with doi: 10.5455/medscience.2023.08.181 Content of this journal is licensed under a Creative Commons Attribution-NonCommercial-NonDerivatives 4.0 International License. CITATION Oguz M, Dogan S, Babaoglu M, et al. Modified naples prognostic score as a potential predictor for coronary slow flow: a retrospective observational study. Med Science. 2023;12(4):1227-31. Abstract e Naples prognostic score (NPS) predicts patient survival in gastroesophageal cancer using parameters related to nutritional and inflammatory status. ese parameters include risk factors for coronary endothelial dysfunction except for low total cholesterol. erefore, we modified the score (mNPS) to include high cholesterol, a risk factor for coronary endothelial dysfunction. We aimed to evaluate the relationship between mNPS and the angiographic epicardial coronary slow flow phenomenon (CSFP). is retrospective study included 301 patients with coronary slow flow who underwent coronary angiography between 2018 and 2022. e mNPS parameters were calculated and the population was divided into three groups based on the calculated parameters. Angiographic findings were classified in the leſt anterior descending (LAD), circumflex (Cx), right coronary (RCA) arteries, and three coronary arteries together. Statistical analyses were performed to identify mNPS as predictors of a slow flow phenomenon. Participants were divided into mNPS Group 1 (n=63), mNPS Group 2 (n=201), and mNPS Group 3 (n=37). No significant differences were observed in age, gender, or medications among the mNPS groups. e RCA had a statistically significant association with mNPS groups for slow flow phenomenon (p=0.006). Considering all three coronary arteries, the association with mNPS groups was also significant (p=0.005). White blood cell and lymphocyte counts showed significant differences. Compared with group 1, group 3 had 4.11 times more coronary artery slow flow. Our study suggests that the mNPS, integrating nutritional and inflammatory parameters along with high cholesterol, holds promise as a potential predictor for the coronary slow flow phenomenon. is could impact risk stratification and clinical management in this patient group. Keywords: Modified naples, prognostic score, coronary slow flow Medicine Science International Medical Journal Introduction The Naples prognostic score (NPS) is a scoring system used to predict patient survival in certain types of gastroesophageal cancer, such as esophageal cancer. This score is based on parameters that reflect the patient's nutritional and inflammatory status and is based on total cholesterol, albumin, lymphocyte- to-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR) [1,2]. Many studies have shown that low albumin, high cholesterol, and chronic inflammation are related to an increased risk of coronary slow flow phenomenon (CSFP) as early stage of coronary artery disease [3-5]. The combination of these risk factors corresponds to the NPS parameters except the cholesterol level. The high serum cholesterol level is a risk factor for coronary endothelial dysfunction and coronary artery disease [6]. As so, the NAPLES score was modified by changing the cholesterol value from low to high. Modified NAPLES (mNPS) might be associated with coronary slow flow by replacing a low cholesterol value with a high value. In this study, we aimed to evaluate the relationship between the modified NPS and angiographic epicardial CSFP. Material and Methods Study design and participants This study was designed as a retrospective observational study and included patients with coronary slow-flow who underwent coronary angiography for suspected coronary artery disease.