The effect of preoperative natriuretic peptide testing on outcome in vascular surgery: a systematic review and meta-analysis

Vollständiger Abstract

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Objective: The aim of this systematic review and meta-analysis was to evaluate the prognostic utility of natriuretic peptide testing for predicting adverse postoperative outcomes in patients undergoing vascular surgery, and to assess their incremental value within established perioperative risk stratification frameworks. Specific endpoints included mortality, myocardial infarction, stroke and prolonged hospitalisation. A secondary objective was to determine whether natriuretic peptide testing offers incremental prognostic value over conventional risk assessment tools. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Embase, Scopus and the Cochrane Library was performed to identify studies published between 2004 and 2025 evaluating the association between preoperative B-type natriuretic peptide (BNP) levels and postoperative outcomes in adult vascular surgery patients. Eligible studies included randomised controlled trials, cohort studies and case–control studies. Two reviewers independently conducted data extraction and quality assessment. A random-effects meta-analysis was performed and subgroup analyses were conducted based on patient characteristics and procedure type. Results: Eleven studies including 3,062 patients were included in the systematic review. All included studies were observational (prospective or retrospective cohorts). Most studies reported a significant association between elevated preoperative BNP levels and increased risk of perioperative cardiac complications including myocardial infarction, myocardial injury and cardiac death. Several studies also suggested an association with short-term mortality, although mortality-specific data were limited. Five studies reporting multivariable-adjusted odds ratios were pooled. Elevated preoperative BNP levels were associated with a significantly increased risk of perioperative cardiac events (pooled OR 4.08; 95% CI 3.20 to 5.20; p