title: [Cardiac biomarkers in perioperative risk stratification].
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. fellahi-jl@chu-caen.fr
authors.forename: J-L
authors.initials: JL
authors.lastname: Fellahi
authors.forename: V
authors.initials: V
authors.lastname: Piriou
authors.forename: D
authors.initials: D
authors.lastname: Longrois
mesh_terms: D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D045265:Natriuretic Peptides / Q000097:blood; D019990:Perioperative Care / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D014336:Troponin; D002097:C-Reactive Protein