Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery

J. H. Choi, D. K. Cho, Y. B. Song, J. Y. Hahn, S. Choi, H. C. Gwon, D. K. Kim, S. H. Lee, J. K. Oh, Eun Seok Jeon

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109 Scopus citations

Abstract

Objective: To investigate whether simple and noninvasive 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, 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 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.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
JournalHeart
Volume96
Issue number1
DOIs
StatePublished - Jan 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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