Abstract: AIM:To investigate the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in predicting perioperative major cardiovascular events (PMCE) in elderly patients undergoing abdominal surgery. METHODS: NT-proBNP was determined preoperatively in 173 patients undergoing surgery. ROC analyses were performed to evaluate the predictive values of plasma NT-proBNP and revised cardiac risk index (RCRI) for perioperative PMCE in elderly patients undergoing abdominal surgery and to identify the optimal NT-proBNP cut-off for predicting perioperative PMCE. RESULTS: Twelve patients developed perioperative complications of PMCE. Preoperative NT-proBNP levels were significantly higher in patients experiencing cardiac events compared with the levels in patients without events (median 452.6 ng/L vs. 67.1 ng/L; NT-proBNP-log 2.72/0.43 vs. 1.82/0.39, P<0.01). In a receiver-operator characteristic (ROC) analysis for the prediction of PMCE, the area under ROC curve for NT-proBNP was significantly higher than the area under ROC curve for RCRI (0.964, 95% CI 0.924-0.986, P<0.01) vs. 0.79, 95% CI 0.722-0.848, P<0.01) (P<0.05). The optimal predictive accuracy was achieved with a NT-proBNP threshold of 230.2 ng/L. CONCLUSION: In elderly patients undergoing abdominal surgery, preoperative NT-proBNP level can predict short-term postoperative PMCE. NT-proBNP is a useful tool in the preoperative evaluation of elderly patients undergoing abdominal surgery.