Bone morphogenetic protein 10 and one-year outcomes after open revascularisation in symptomatic peripheral arterial disease or carotid stenosis

Abstract Background Bone morphogenetic protein 10 (BMP10) has atrial-specific and vascular properties and may reflect both atrial and vascular pathophysiology. We investigated whether BMP10 levels were associated with new-onset atrial fibrillation (AF), major adverse cardiovascular events (MACE), and all-cause mortality after open revascularisation for symptomatic peripheral arterial disease (PAD) or carotid stenosis (CS). Methods Patients scheduled for endarterectomy for symptomatic PAD or CS were enrolled. BMP10 concentrations were measured using a multiplex immunoassay. Clinical outcomes were obtained from medical records during one-year follow-up. Associations between BMP10 and outcomes were assessed using Cox proportional hazards regression. Results A total of 210 patients were included (63% men; 61% underwent surgery for PAD). Women were older than men and had higher BMP10 levels. Forty patients had known preoperative AF. During one-year follow-up, 26 patients experienced MACE and 13 died. Among 170 patients without AF at baseline, 10 developed new-onset AF. In unadjusted Cox regression, higher BMP10 levels were associated with MACE (HR 1.01, 95% CI 1.00-1.03; p = 0.047) and all-cause mortality (HR 1.03, 95% CI 1.01–1.04; p < 0.001), but not with new-onset AF (HR 1.00, 95% CI 0.97–1.03; p = 0.80). Effect estimates were similar after adjustment for age and sex. Model-based point estimates of one-year cumulative incidence were numerically higher at higher BMP10 concentrations for MACE and all-cause mortality, although confidence intervals were wide; no corresponding pattern was observed for new-onset AF. Conclusions In this exploratory cohort, higher BMP10 levels were associated with MACE and all-cause mortality after endarterectomy for symptomatic PAD or CS. Women had higher BMP10 levels than men. These findings should be interpreted cautiously and considered hypothesis-generating; larger studies are required to validate the observed associations.