Thanks to all that replied to my question about the use of serum myoglobin
to rule out ACS.
The background to the question is that our clinicians are keeping low risk
patients in for 12 hours to wait for a cTnT- and then discharging on the
basis of a normal cTnT. The impression is that this uses more bed resources
than before cTnT was introduced. Their question was whether a biochemical
test could be used to rule OUT ACS in low risk patients (based on ECG and
Clinical assessment) and send the patient home earlier than 12 hours.
The replies I received confirmed my view that serum myoglobin does not have
either the sensitivity or specificity to RULE OUT ACS at 6 hours. I
received one reply where two serial CKMB mass measurements, one on admission
(0 h) and a second 6 h later is being used for ruling out acute MI in low
risk patients. One reply indicated that Cobalt Binding Albumin may be a
future marker to address the early rule out issue.
In practice, from the replies I got, and the lack of suggestion that I was
years out of date!, it appears that a biochemical test to rule out ACS and
send a patient home at 6 hours is not common practice despite this being
suggested in reviews and papers
regards
martin myers
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