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. 2010 Jan;96(1):56-62.
doi: 10.1136/hrt.2009.181388. Epub 2009 Oct 26.

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

J-H Choi  1 , 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
Affiliations

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

J-H Choi et al. Heart. 2010 Jan.

Abstract

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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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Clinical outcomes according to the risk predictors. AMI, acute myocardial infarction; CV death, primary cardiovascular death; PMCE, perioperative major cardiovascular event; PE, pulmonary oedema. *p<0.001 by Jonckheere-Terpstra test for trend.
Figure 3
Figure 3
Receiver-operating characteristic (ROC) analysis of perioperative risk predictors. The predictive power of each combination of categorised risk predictor in an additive manner was investigated. Risk predictors were categorised according to the optimal cut-off levels derived from ROC analysis, which were 2 for RCRI, 301 ng/l for BNP and 3.4 mg/l for CRP. Areas under the curve (AUCs) with 95% CI are shown below each panel. *p<0.05 by Hanley and McNail methods. (A) ROC for PMCE. *p<0.001 for all, except RCRI + NT-proBNP vs RCRI + NT-proBNP + CRP (p = 0.001), and RCRI + CRP vs RCRI + NT-proBNP (p = 0.010). (B) ROC for AMI. *p<0.001 for all, except RCRI + NT-proBNP vs RCRI + NT-proBNP + CRP (p = 0.026), RCRI + CRP vs RCRI + NT-proBNP + CRP (p = 0.002) and RCRI + CRP vs RCRI + NT-proBNP (p = 0.590). (C) ROC for pulmonary oedema. *p<0.001 for all, except RCRI + CRP vs RCRI + NT-proBNP (p = 0.004) and RCRI + NT-proBNP vs RCRI + NT-proBNP + CRP (p = 0.001). (D) ROC for primary cardiovascular death. *RCRI vs CRP, p = 0.021; RCRI vs RCRI + NT-proBNP, p = 0.012; RCRI vs RCRI + NT-proBNP + CRP, p = 0.002; RCRI + CRP vs RCRI + NT-proBNP + CRP, p = 0.021. AMI, acute myocardial infarction; CV death, primary cardiovascular death; PE, pulmonary oedema; PMCE, perioperative major cardiovascular event.
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Comment in

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