RESUMEN
Measurement of cardiac troponin I or T in serum (highly specific for the myocardium) have replaced classical markers, such as creatine kinase MB. Cardiac troponins are preferred markers because of their high specificity and sensitivity. This had led to modifications of the original World Health Organization criteria for acute myocardial infarction. Furthermore, the place of the troponins as superior markers of subsequent cardiac risk in acute coronary syndrome has now become firmly established, for both diagnostic and risk stratification purposes. The use of C-reactive protein and/or other inflammatory biomarkers may add independent information in this context. After non cardiac surgery, the total cardiospecificity of cardiac troponins explains why other biomarkers of necrosis should no longer be used. Recent studies suggest that any elevation of troponin in the postoperative period is indicative of increased risk of long-term cardiac complications. This prognostic value has been previously demonstrated in other clinical settings such as invasive coronary intervention (surgical myocardial revascularization and percutaneous coronary intervention) and after heart valve surgery. Increases of troponin indicate cardiac damage, whatever the mechanism (ischemic or not). Other causes of cardiac injury include: pulmonary embolism, myocarditis, pericarditis, congestive heart failure, septic shock, myocardial contusion. In most cases, elevation of troponins has been shown to be associated with a bad outcome.
Asunto(s)
Troponina I/sangre , Troponina T/sangre , Periodo de Recuperación de la Anestesia , Angina Inestable/sangre , Biomarcadores/sangre , Árboles de Decisión , Humanos , Infarto del Miocardio/sangreRESUMEN
The reasons for 186 medically indicated terminations of pregnancy, 178 stillbirths, and 126 neo-natal deaths were analysed by a multi-disciplinary team after a thorough enquiry into the social and medical context for the deaths or for the decision to interrupt the pregnancies. This was undertaken on the initiative of the regional technical consultative commission for enquiring into births, and according to a protocol that had already been partly used by a group studying the neonatal period in Ille and Vilaine. A comparison of the causes according to the type of death shows the value of following up these three indicators to the plan and appropriate policy for three weeks following delivery. A certain number of questions about definitions and classifications still have arisen.