Background: Perioperative cardiac complication is a major cause of morbidity after noncardiac surgery. We hypothesized that measurement of cardiovascular biomarkers may have an additional value in predicting perioperative cardiac complications. Methods: A cohort of 1021 patients referred for cardiac consultation before elective noncardiac surgery was enrolled prospectively. The level of hsCRP and NT-proBNP were measured within 2 weeks before surgery. Perioperative cardiac event (POCE) was defined as acute myocardial infarction, congestive heart failure including acute pulmonary edema or primary cardiac death within 5 days after surgery. Results: POCEs occurred in 97 (9.5%) of the 1021 patients. The optimal cut-off value of NT-proBNP (��� 340 pg/ml, sensitivity=77.3%, specificity=75.9%) and hsCRP (��� 0.495 mg/dl, sensitivity=61.2%, specificity=73.8%) for prediction of POCE was derived from receiver operating characteristic analysis. Multivariable logistic regression analyses revealed that both preoperative high NT-proBNP and hsCRP was an independent predictor of POCE. Next, we compared the performance of predicting POCEs by comparing the area under receiver operating characteristic (ROC) curves. When a high preoperative NT-proBNP (��� 340 pg/ml) and hsCRP (��� 0.495 mg/dl) was combined with the Revised Cardiac Risk Index, the prediction power has significantly strengthened (area under ROC curve; 0.772 versus 0.660, p = 0.0001). Conclusions: A high preoperative NT-proBNP (��� 340 pg/ml) and hsCRP (��� 0.495 mg/dl) is a strong and independent predictor of POCE. Measurement of cardiovascular biomarkers may have a role in preoperative cardiac risk index development.