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

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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.
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  • Örebro University

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