Roth Sebastian, Huhn Ragnar, Jung Christian, Polzin Amin, De Hert Stefan, Lurati Buse Giovanna
Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Med Klin Intensivmed Notfmed. 2022 Jun;117(5):381-388. doi: 10.1007/s00063-021-00788-2. Epub 2021 Feb 9.
Yearly, more than 200 million people worldwide undergo noncardiac surgery of whom about 5% will suffer adverse cardiac events. Therefore, risk stratification and early detection of these events is crucial.
The goal of this review is to summarize the currently available evidence on the role of biomarkers in perioperative cardiac risk assessment. It presents current data of the established biomarkers troponin and brain natriuretic peptide (BNP), and it also reports on new biomarkers that are still under evaluation, e.g. copeptin (a marker of neurohumoral activation) and presepsin (an inflammation marker).
Narrative review.
According to currently available data, there is a strong association between preoperative troponin or BNP values and postoperative adverse cardiac events and mortality. However, to date, there is only a weak recommendation for routine measurement of these biomarkers even in high-risk patients because the evidence on outcome improvement is still very limited. The evidence on treatment options in case of increased postoperative troponin values is also scarce so that international guidelines come to different conclusions regarding postoperative measurement of toponin. Meanwhile, several new biomarkers are under evaluation.
全球每年有超过2亿人接受非心脏手术，其中约5%会发生不良心脏事件。因此，对这些事件进行风险分层和早期检测至关重要。
本综述的目的是总结目前关于生物标志物在围手术期心脏风险评估中作用的现有证据。它展示了已确立的生物标志物肌钙蛋白和脑钠肽（BNP）的当前数据，还报告了仍在评估中的新生物标志物，如 copeptin（神经体液激活标志物）和 presepsin（炎症标志物）。
叙述性综述。
根据现有数据，术前肌钙蛋白或BNP值与术后不良心脏事件及死亡率之间存在密切关联。然而，迄今为止，即使对于高危患者，也仅有微弱的建议进行这些生物标志物的常规检测，因为关于改善预后的证据仍然非常有限。关于术后肌钙蛋白值升高时治疗选择的证据也很少，以至于国际指南对于术后肌钙蛋白的检测得出了不同结论。与此同时，几种新的生物标志物正在评估中。
