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35 The (troponin) – manchester acute coronary syndrome rules in the emergency department systematic review and meta-analysis
  1. Garry McDowell1,
  2. Amy McMullen1,
  3. Malak Al-Mashali1,
  4. Catrin Austin2,
  5. Nina Dempsey-Hibbert1,
  6. Martin Stout1,
  7. Mark Slevin1,
  8. Richard Body3
  1. 1Manchester Metropolitan University
  2. 2NICE
  3. 3University of Manchester


Introduction Chest pain is one of the most common reasons for emergency hospital admission. The Manchester Acute Coronary Syndrome (MACS), and subsequent Troponin only-MACS (T-MACS), rule risk stratify patients presenting with chest pain into 4 groups (Very low risk, low risk, moderate risk and high risk) with the aim of enabling immediate rule-in or rule-out of acute coronary syndromes in the ED. Low risk patients can be safely discharged from the ED with low probability of major adverse cardiac events (MACE) without further testing. We aimed to summarise the evidence for the use of the (T)MACS rules in the immediate rule-out of ACS in the ED in the very low risk category by undertaking a systematic review and meta-analysis.

Methods We performed a keyword literature search of MEDLINE, EMBASE and Web of Science using MACS, T-MACS and acute coronary syndrome as search terms. After removal of duplicates, 2 authors reviewed the title and abstract to shortlist for full text review. Data was extracted independently by 2 authors, with disagreement resolved by discussion. Outcomes included were prevalent AMI and incident MACE. Quality assessment was performed using a QUADAS-2 model and meta-analysis was performed using STATA 15 running the METANDI and MIDAS commands.

Results 9 studies were included (5 reporting T-MACS and 4 MACS). Data showing the summary AUC, combined sensitivity, and specificity for prevalent AMI and incident MACE in the very low risk (safe for immediate discharge) strata are shown in Table 1. Representative Forrest Plots for MACS and T-MACS are shown in figures 1 and 2 respectfully.

Abstract 35 Table 1 Combined summary sensitivity and specificity of the MACS and T-MACS rules for the exclusion of AMI and ACS in the very low risk (for immediate discharge) strata of patients admitted to the ED with chest pain.

Conclusion The MACS and T-MACS rules provide an accurate tool to identify a low risk chest pain population safe for immediate discharge from ED without the need for followup biomarker testing, with high sensitivity for AMI and ACS.

Conflict of Interest None

  • Acute coronary syndromes
  • decision rules
  • MACS and T-MACS rule

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