Background The prediction of the perioperative cardiovascular complication is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to predict the outcome, but more simple, practical and accurate method was needed. The purpose of this study was to determine whether N-termial pro-brain natriuretic peptide (NT-proBNP) concentration before operation can be used to predict perioperative cardiovascular complication in elderly patients underwent noncardiac surgery.
Methods We studied 279 patients older than 60 years, who were scheduled to elective surgery. The plasma NT-proBNP concentration, clinical cardiac indices and left ventricular ejection fraction were measured prior to operation. The postoperative cardiac outcomes were followed and predictors for postoperative cardiac risk were identified.
Results Cardiovascular complication was occurred in 25 patients (9.0%). Age, the incidence of prior ischemic heart disease or congestive heart failure, and the plasma NT-proBNP concentration were significantly higher in patients with perioperative cardiovascular complications than in those without complication. Using receiver operating characteristic analysis to predict perioperative cardiovascular events, a cut-off value of 183 pg/ml was identified as the optimal predictor of perioperative complications, showing sensitivity of 80.0% and specificity of 81.1%. Multivariate analysis revealed that NT-proBNP >183 pg/ml (OR 7.1, 95% CI 2.0-25.3, p=0.003) and revised cardiac index ���2 (OR 6.6, 95% CI 1.7-24.7, p=0.005) were independent predictors for perioperative cardiovascular complications.
Conclusions Elevated NT-proBNP levels are independently associated with the increase in the risk of perioperative cardiovascular complications in elderly patients with noncardiac and nonvascular operation.