Format

Send to

Choose Destination
See comment in PubMed Commons below
Heart. 2014 Sep 15;100(18):1462-8. doi: 10.1136/heartjnl-2014-305564. Epub 2014 Apr 29.

The Manchester Acute Coronary Syndromes (MACS) decision rule for suspected cardiac chest pain: derivation and external validation.

Author information

1
Cardiovascular Sciences Research Group, The University of Manchester, Manchester, UK Emergency Department, Central Manchester University Hospitals Foundation NHS Trust, Manchester, UK.
2
Emergency Department, Central Manchester University Hospitals Foundation NHS Trust, Manchester, UK Department of Health & Social Care, Manchester Metropolitan University, Manchester, UK.
3
Cardiovascular Sciences Research Group, The University of Manchester, Manchester, UK.
4
Emergency Department, Central Manchester University Hospitals Foundation NHS Trust, Manchester, UK.
5
Biochemistry Department, Stockport Hospital, Stockport NHS Foundation Trust, Stockport, UK.
6
Department of Epidemiology, Stockport Hospital, Stockport NHS Foundation Trust, Stockport, UK.
7
Cardiology Department, Stockport Hospital, Stockport NHS Foundation Trust, Stockport, UK.

Abstract

OBJECTIVE:

We aimed to derive and validate a clinical decision rule (CDR) for suspected cardiac chest pain in the emergency department (ED). Incorporating information available at the time of first presentation, this CDR would effectively risk-stratify patients and immediately identify: (A) patients for whom hospitalisation may be safely avoided; and (B) high-risk patients, facilitating judicious use of resources.

METHODS:

In two sequential prospective observational cohort studies at heterogeneous centres, we included ED patients with suspected cardiac chest pain. We recorded clinical features and drew blood on arrival. The primary outcome was major adverse cardiac events (MACE) (death, prevalent or incident acute myocardial infarction, coronary revascularisation or new coronary stenosis >50%) within 30 days. The CDR was derived by logistic regression, considering reliable (κ>0.6) univariate predictors (p<0.05) for inclusion.

RESULTS:

In the derivation study (n=698) we derived a CDR including eight variables (high sensitivity troponin T; heart-type fatty acid binding protein; ECG ischaemia; diaphoresis observed; vomiting; pain radiation to right arm/shoulder; worsening angina; hypotension), which had a C-statistic of 0.95 (95% CI 0.93 to 0.97) implying near perfect diagnostic performance. On external validation (n=463) the CDR identified 27.0% of patients as 'very low risk' and potentially suitable for discharge from the ED. 0.0% of these patients had prevalent acute myocardial infarction and 1.6% developed MACE (n=2; both coronary stenoses without revascularisation). 9.9% of patients were classified as 'high-risk', 95.7% of whom developed MACE.

CONCLUSIONS:

The Manchester Acute Coronary Syndromes (MACS) rule has the potential to safely reduce unnecessary hospital admissions and facilitate judicious use of high dependency resources.

PMID:
24780911
PMCID:
PMC4174131
DOI:
10.1136/heartjnl-2014-305564
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center