Key result
MACS and T-MACS show high sensitivity for ruling out ACS and detecting 30-day MACE.
Why the study?
The ability of the MACS and T-MACS decision aids to safely rule out acute coronary syndromes in ED patients with suspected cardiac chest pain was uncertain.
Can the Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids safely rule out acute coronary syndromes in patients presenting to the ED with suspected cardiac chest pain?
Can the Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids safely rule out acute coronary syndromes in patients presenting to the ED with suspected cardiac chest pain?
Both MACS and T-MACS decision aids demonstrate high sensitivity for ruling out acute coronary syndromes and 30-day MACE in the emergency department.
Supports consideration of MACS/T-MACS in ED pathways; leaves open need for prospective validation before routine use.
A short-cut review was carried out to establish whether the Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids can safely rule out acute coronary syndromes in patients presenting to the ED with suspected cardiac chest pain. Six studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that both rules have high sensitivity for acute coronary syndromes, including the detection of major adverse cardiac events at 30 days. The original MACS algorithm may have marginally greater sensitivity than T-MACS but has inferior specificity and requires the use of a biomarker assay (for heart-type fatty acid binding protein) that is not currently widely used in practice.
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Reynard et al. (2017) conducted a review in suspected cardiac chest pain. Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids was evaluated on acute coronary syndromes and major adverse cardiac events at 30 days. The MACS and T-MACS decision aids both demonstrated high sensitivity for ruling out acute coronary syndromes and detecting major adverse cardiac events at 30 days.
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