Clinical utility of biomarkers in myocardial injury.
OBJECTIVE
This review will focus on recent developments in biomarkers of myocardial injury. We will discuss the clinical utility of cardiac-specific troponin in the post-operative setting and highlight some of the most promising new biomarkers under development.


RESULTS
Troponin I and T, measured in the post-operative setting, have been recently shown to have strong short- and long-term prognostic information in cardiac and vascular surgery patients. This ability of troponins to risk stratify post-operative patients occurs independent of clinical factors and other biomarkers. Additionally, brain natriuretic peptide has garnered significant interest as a biomarker of neurohormonal activation and appears to yield independent prognostic information from troponins. Recent studies have introduced two new biomarkers, soluble CD40 ligand and ischemia-modified albumin, which may aid in both diagnostic and prognostic decision making.


CONCLUSIONS
The current data strongly supports the use of troponin I and T in post-operative non-cardiac and cardiac surgical patients to assist in identifying those patients at high risk for short- and long-term complications. Several promising new biomarkers are currently under development but further studies are warranted to define their role in the post-operative setting.
Chan
Michael Y
MY
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Pronovost
Peter J
PJ