RT Journal Article
SR Electronic
T1 Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 56
OP 62
DO 10.1136/hrt.2009.181388
VO 96
IS 1
A1 J-H Choi
A1 D K Cho
A1 Y-B Song
A1 J-Y Hahn
A1 S Choi
A1 H-C Gwon
A1 D-K Kim
A1 S H Lee
A1 J K Oh
A1 E-S Jeon
YR 2010
UL http://heart.bmj.com/content/96/1/56.abstract
AB 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.