Fellahi J-L, Piriou V, Longrois D
Pôle anesthésie-réanimation-Samu-hémovigilance-coordination hospitalière, CHU de Caen, UFR de médecine, université de Caen-Basse Normandie, avenue de la Côte-de-Nacre, Caen cedex 9, France.
Ann Fr Anesth Reanim. 2011 Feb;30(2):126-40. doi: 10.1016/j.annfar.2010.11.025. Epub 2011 Feb 1.
The field of new cardiac biomarkers has triggered physicians' enthusiasm because of their potential diagnostic and prognostic values for routine clinical practice in the surgical setting. The objective of the present article is to review the role of new cardiac biomarkers and their potential additive clinical value in predicting short- and long-term risk following cardiac and non-cardiac surgery.
A PubMed(®) database research in English and French languages published until June 2010. Keywords were cardiac biomarkers, troponins, cardiac troponin I (cTnI), natriuretic peptides, B-type natriuretic peptide (BNP), C-reactive protein (CRP), multiple markers approach, risk stratification, clinical risk scores.
Numerous publications deal with the diagnostic and prognostic values of new cardiac biomarkers in cardiac and non-cardiac surgical settings and provide an increasing evidence of their interest, validating different hierarchical steps which are mandatory before recommending a wide use of biomarkers for routine practice. Even if the first studies demonstrating an additional prognostic value of serum postoperative cTnI and/or preoperative BNP when compared with clinical predictive models are now available, we still lack data concerning an actual positive impact of new biomarkers measurements on clinical decision making or practice, as well as patient care and outcome.
While use of new cardiac biomarkers in the perioperative period appears to be a simple and objective tool for risk stratification at the bedside, we still need to remain cautious concerning their additional clinical value on existing predictive models for routine practice.
新型心脏生物标志物领域因其在外科手术环境中的常规临床实践中具有潜在的诊断和预后价值，引发了医生们的热情。本文的目的是综述新型心脏生物标志物的作用及其在预测心脏和非心脏手术后短期和长期风险方面的潜在附加临床价值。
截至2010年6月发表的英文和法文PubMed(®)数据库研究。关键词为心脏生物标志物、肌钙蛋白、心肌肌钙蛋白I（cTnI）、利钠肽、B型利钠肽（BNP）、C反应蛋白（CRP）、多标志物方法、风险分层、临床风险评分。
众多出版物探讨了新型心脏生物标志物在心脏和非心脏手术环境中的诊断和预后价值，并越来越多地证明了它们的价值，验证了在推荐广泛使用生物标志物进行常规实践之前必须经过的不同层次步骤。即使现在已有首批研究表明，与临床预测模型相比，术后血清cTnI和/或术前BNP具有额外的预后价值，但我们仍然缺乏关于新型生物标志物测量对临床决策或实践以及患者护理和结局的实际积极影响的数据。
虽然围手术期使用新型心脏生物标志物似乎是一种在床边进行风险分层的简单而客观的工具，但对于它们在常规实践的现有预测模型中的附加临床价值，我们仍需谨慎对待。
