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    Tuesday, February 18, 2003

    Broken Hearts: Like DB, this new test for diagnosing heart attacks took me by surprise. It’s a blood test based on an easily measured protein in the blood, albumin. In a healthy person, cobalt binds easily to albumin taken from the blood, but for some reason, when the heart muscle has been damaged, it doesn’t. The new test measures the ability of a sample of serum albumin to bind cobalt, supposedly improving the diagnosis of heart attacks, when combined with EKG’s and troponin levels:

    In a study of 200 patients, doctors were 50 percent accurate in ruling out a heart attack using just an EKG and troponin test. But when they added the new test, doctors accurately ruled out a heart attack 70 percent of the time, FDA said.

    Hmmm. Here’s what I’m saying to myself. I’ve got a thirty-percent chance of sending this patient home with a heart attack, even though all of his tests are OK. A thirty percent chance that I’ll be reading his obituary in a couple of days or leaving him a cardiac cripple. Or getting sued. Am I going to send him home? Nope. Sorry. Odds just aren’t good enough in a life or death situation. I’m going to admit him and do all the usual tests to be certain I’m not missing the one in three.

    Now, if I have a patient with a normal EKG and normal troponin, but an abnormal albumin cobalt binding test, I might be more inclined to put him in the cardiac intensive care unit and to get a cardiology consult. But then, according to one study, the albumin cobalt binding test may be abnormal in the presence of any tissue hypoxia:

    A third issue is that unlike troponin, ACB [albumin cobalt binding] Test measurements do not indicate necrosis; rather, ACB measurements reflect modifications in the NH2 terminus of albumin produced by extracellular hypoxia, acidosis, free radical injury, and sodium and calcium pump disruptions. Therefore, ischemia in the absence of necrosis may cause bias toward apparent false-positive ACB data by yielding a positive ACB Test result associated with a negative cTnI.[troponin]

    Sigh. Nothing’s ever straightforward, is it?

    posted by Sydney on 2/18/2003 05:44:00 AM 0 comments


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