Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery

Vascular surgery is associated with a substantial risk of cardiovascular events and death.1,2 There is no effective method for determining cardiac risk preoperatively: validated risk prediction instruments are limited by complexity and poor predictive value, and other cardiac investigations such as nuclear stress testing and coronary angiography are limited by time and resources. For these reasons, alternative methods that can predict outcome of at risk patients would be an important advance. Plasma brain natriuretic peptide (BNP) has counter-regulatory vasodilator and natriuretic properties. Plasma BNP concentrations are often increased in cardiac disorders, such as angina and heart failure. The plasma concentrations of BNP are related to prognosis in these conditions.3 Many of these cardiovascular conditions occur in patients with peripheral vascular disease. We investigated the predictive value of preoperative plasma BNP concentration for the occurrence of perioperative fatal or non-fatal myocardial infarction (MI) in high risk vascular surgical patients. We also compared the predictive value of plasma BNP concentration with the Eagle score, a conventional surgical risk assessment instrument.1,2 We screened consecutive patients undergoing major surgery for aortic or peripheral arterial occlusive disease in Gartnavel General Hospital, Glasgow, between April and September 2004. All patients at high risk, defined according to the American Society of Anesthesiology …