JOURNAL ARTICLE

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, E-S Jeon
Heart 2010, 96 (1): 56-62
19861299

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, 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.

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