Pre-Operative B-Type Natriuretic Peptide As A Prognostic Indicator For Major Adverse Cardiac Events In Vascular Surgery Patients

Introduction: Patients undergoing vascular surgery experience higher rates of perioperative morbidity and mortality, including adverse cardiovascular events due to their associated cardiovascular disease burden. Previous research highlights that elevated pre-operative Brain Natriuretic Peptide (BNP) is highly predictive of adverse cardiovascular events following noncardiac surgery. The aim of this review is to assess the utility of preoperative B-type natriuretic peptide (BNP) to independently predict major adverse cardiovascular events (MACE), within 30 days of major vascular surgery. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Online databases Embase, Pubmed and Cochrane Library were searched for randomised controlled trials, controlled clinical trials and observational studies reporting preoperative BNP concentrations with primary study end point of MACE following major elective vascular surgery. Studies with a minimum follow up period of 30 days were included. Relevant search terms were used to identify papers. Congress abstracts, grey literature and unpublished trials were also searched. Results: A total of 6265 studies were identifed, with 919 duplicates removed. 5346 studies were screened by two independent reviewers of which, 103 full text articles were screened. 12 full-text articles meeting our eligibility criteria were included for analysis, all of which were prospective observational studies. These included 1,760 elective vascular procedures including open AAA repair (n=670), carotid endarterectomy (n=453) and lower limb arterial reconstruction (n=637). Conclusion: Across all studies, high preoperative serum BNP concentration predicted postoperative cardiac events in the follow-up period. Preoperative BNP is a useful tool to predict cardiovascular events after major vascular surgery