Aim We investigated the prognostic value of preoperative N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in non‐cardiac surgery in elderly patients who showed normal left ventricular function on preoperative echocardiography. Methods We analyzed 1459 patients aged older than 70 years who had consulted a cardiologist for the evaluation of cardiovascular risk for non‐cardiac surgery. Of the 721 patients who simultaneously underwent echocardiography and NT‐proBNP assessments, 506 who showed normal left ventricular systolic function were included. The predictive power of NT‐proBNP for the risk of major adverse cardiac and cerebrovascular events (MACCE) was evaluated. Results MACCE occurred in 40 (7.9%) of the 506 patients, and the median value of NT‐proBNP was higher in patients with complications than in those without (MACCE group: 1700.5 pg/mL vs non MACCE group: 206.35 pg/mL; P < 0.001). The area under the receiver operating characteristic curve was 0.804 (P < 0.001), with an optimal cut‐off of 425.3 pg/mL. Multivariate analysis showed that increased NT‐proBNP (>425.3 pg/mL; odds ratio 6.381; P < 0.001) was the only independent risk factor for the prediction of MACCE. Conclusions In elderly patients who showed normal left ventricular systolic function on echocardiography, measurement of preoperative NT‐proBNP concentration might be a useful test for predicting the occurrence of MACCE after non‐cardiac surgery. Geriatr Gerontol Int 2016; 16: 1109–1116.