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


METHODS
Prospective, single-centre, cohort study.


METHODS
A 1900-bed tertiary-care university hospital in Seoul, Korea Design and


METHODS
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.


METHODS
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.
Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
J-H
JH
Choi
D K
DK
Cho
Y-B
YB
Song
J-Y
JY
Hahn
S
S
Choi
H-C
HC
Gwon
D-K
DK
Kim
S H
SH
Lee
J K
JK
Oh
E-S
ES
Jeon
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011300:Preoperative Care; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000517:prevention & control*; D018570:Risk Assessment
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein