Association between neutrophil percentage-to-albumin ratio and adverse clinical outcomes after successful percutaneous coronary intervention for chronic total occlusion: a cohort study.

Authors

Song Wen, Xingjie Huang, Zehan Huang, Yuqing Huang, Hua Yang, Bin Zhang

Published in

Frontiers in immunology. Volume 17. Pages 1882018. Epub Jul 09, 2026.

Abstract

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has improved outcomes, yet residual cardiovascular risk persists. The neutrophil percentage-to-albumin ratio (NPAR), an integrated marker of inflammation and nutritional status, has not been examined in successfully revascularized CTO patients. We investigated whether NPAR is independently associated with long-term adverse outcomes in this population.
This single-center retrospective cohort study included 1513 consecutive patients who underwent successful CTO PCI. NPAR was calculated as (neutrophil percentage × 100)/albumin (g/dL). The primary endpoint was all-cause mortality, secondary endpoints were cardiovascular mortality and cardiovascular events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke). Multivariable Cox regression and restricted cubic splines (RCS) assessed the association between NPAR and clinical outcomes. Time-dependent Receiver operating characteristics (ROC) curves were used to evaluate the ability for NPAR to predict all-cause mortality.
During a median follow-up of 810 days, 83 (5.5%) all-cause deaths, 53 (3.5%) cardiovascular deaths, and 73 (4.8%) cardiovascular events occurred. After multivariable adjustment, each 1-standard deviation increase in NPAR was associated with a 50% higher risk of all-cause mortality (HR 1.50, 95% CI 1.23-1.83, P<0.001), a 59% higher risk of cardiovascular mortality (HR 1.59, 95% CI 1.23-2.05, P<0.001), and a 42% higher risk of cardiovascular events (HR 1.42, 95% CI 1.13-1.79, P = 0.003). RCS analysis revealed a linear association between NPAR and all-cause mortality (P for non-linearity = 0.971), cardiovascular mortality (P for non-linearity = 0.150), and major cardiovascular events (P for non-linearity = 0.152). Time-dependent ROC analyses demonstrated that adding NPAR to a basic model comprising age, multi-vessel disease, and LVEF significantly improved discrimination for all-cause mortality at 1, 2, and 3 years (ΔAUC 0.092, 0.076, and 0.058, respectively; all P < 0.0001). The optimal NPAR cut-off values derived from the maximum Youden index were stable across all three time points (15.71, 16.18, and 15.37, respectively), yielding sensitivities of 71.8% to 72.6% and specificities of 73.2% to 75.7%.
In patients undergoing successful CTO PCI, elevated NPAR is independently and linearly associated with increased long-term mortality and major cardiovascular events. This simple, objective biomarker may refine post-intervention risk stratification and identify high-risk individuals warranting intensified secondary prevention.

PMID:
42495601
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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