Background: We sought to determine the role of preoperative predictors on perioperative cardiovascular events after noncardiac vascular surgery. Methods: One hundred eleven patients scheduled for major noncardiac vascular surgery were prospectively evaluated including by echocardiography and NT-pro-BNP measurements within 2 weeks before surgery. Multivariable logistic regression analysis was performed to evaluate the predictors of perioperative cardiac event (POCE) within 5 days after surgery. Receiver-operating characteristic analysis was performed to determine the optimal cut-off value of NT-pro-BNP to predict outcome. Results: Cardiac events occurred in 20 (18.02%) of 111 patients; in 6 of 76 patients with NT-pro-BNP <350 pg/ml (i.e., the optimal cut-off value to predict cardiac events) and in 14 of 35 patients (42%) with NT-pro-BNP >or=350 pg/ml (unadjusted odds ratio 7.78, 95% confidence interval 2.66 to 22.76, p <0.0001). After adjustment for cardiac risk factors, NT-pro-BNP and reduced left ventricular systolic function (ejection fraction < 40%) were significantly associated with perioperative cardiac events. The area under ROC curve was 0.738 for plasma NT-pro-BNP (p = 0.001). Conclusion: In patients who undergo major vascular surgery, elevated plasma NT-pro-BNP levels and decreased left ventricular systolic function are independently associated with an increased risk for perioperative cardiac events.