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Preoperative NT-proBNP and CRP Predict Perioperative Major Cardiovascular Events in Noncardiac Surgery
  1. Jin-Ho Choi1,
  2. Dae Kyoung Cho2,
  3. Young-Bin Song1,
  4. Joo-Yong Hahn1,
  5. Seunghyuk Choi1,
  6. Hyeon-Cheol Gwon1,
  7. Duk-Kyung Kim1,
  8. Sang Hoon Lee1,
  9. Jae K Oh3,
  10. Eun-Seok Jeon1,*
  1. 1 Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea, Republic of;
  2. 2 Jeju Hanmaeum General Hospital, Korea, Republic of;
  3. 3 Mayo Clinic College of Medicine, United States
  1. Correspondence to: , ; esjeon{at}


Objective: To investigate whether simple and non-invasive measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) and/or C-reactive protein (CRP) can predict perioperative major cardiovascular event (PMCE).

Design: Prospective, single center, cohort study.

Setting: A 1900-bed tertiary-care university hospital in Seoul, Korea

Design and patients: The predictive power of NT-proBNP, CRP, and Revised Cardiac Risk Index (RCRI) for the risk of PMCE (myocardial infarction, pulmonary edema, or cardiovascular death) were evaluated from a prospective cohort of 2054 elective major noncardiac surgery patients. Optimal cut-off values were derived from receiver operating characteristic curve (ROC) analysis.

Main outcome measurement: PMCE (myocardial infarction, pulmonary edema, or cardiovascular death) within postoperative 30 days.

Results: PMCE developed in a total of 290 patients (14.1%). Each increasing quartile of NT-proBNP or CRP level was associated with a greater risk of PMCE after adjustment for traditional clinical risk factors. The relative risk (RR) of highest versus lowest quartile was 5.2 for NT-proBNP (p<0.001) and 3.7 for CRP (p<0.001). Both NT-proBNP (cut-off = 301 ng/L) and CRP (cut-off = 3.4 mg/L) predicted PMCE better than RCRI (cut-off = 2) by ROC analysis (p<0.001). Moreover, the predictive power of RCRI (adjusted RR = 1.5) could be improved significantly by addition of CRP and NT-proBNP to RCRI (adjusted RR = 4.6) (p<0.001).

Conclusions: High preoperative NT-proBNP or CRP is a strong and independent predictor of perioperative major cardiovascular event in non-cardiac surgery. The predictive power of current clinical risk evaluation system would be strengthened by these biomarkers.

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