TY - JOUR T1 - Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery JF - Heart JO - Heart SP - 56 LP - 62 DO - 10.1136/hrt.2009.181388 VL - 96 IS - 1 AU - J-H Choi AU - D K Cho AU - Y-B Song AU - J-Y Hahn AU - S Choi AU - H-C Gwon AU - D-K Kim AU - S H Lee AU - J K Oh AU - E-S Jeon Y1 - 2010/01/01 UR - http://heart.bmj.com/content/96/1/56.abstract N2 - 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-centre, cohort study.Setting: A 1900-bed tertiary-care university hospital in Seoul, KoreaDesign and patients: The predictive power of NT-proBNP, CRP and Revised Cardiac Risk Index (RCRI) for the risk of PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) were evaluated from a prospective cohort of 2054 elective major non-cardiac surgery patients. Optimal cut-off values were derived from receiver operating characteristic curve (ROC) analysis.Main outcome measurement: PMCE (myocardial infarction, pulmonary oedema 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. ER -