PMID- 29079376
OWN - NLM
STAT- MEDLINE
DCOM- 20181123
LR  - 20181123
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 36
IP  - 4
DP  - 2018 Apr
TI  - Validation of the (Troponin-only) Manchester ACS decision aid with a contemporary
      cardiac troponin I assay.
PG  - 602-607
LID - S0735-6757(17)30757-X [pii]
LID - 10.1016/j.ajem.2017.09.032 [doi]
AB  - OBJECTIVES: The Manchester Acute Coronary Syndromes (MACS) decision aid can
      'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's
      symptoms with the results of a single blood test taken at the time of arrival in 
      the Emergency Department (ED). The original model (MACS) included two biomarkers:
      high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding
      protein (h-FABP). A refined model without h-FABP was found to have comparable
      sensitivity but greater specificity. We sought to validate MACS and T-MACS using 
      the contemporary Siemens Advia Centaur cardiac troponin I assay to increase
      usability in practice. METHODS: This is a secondary analysis from prospective
      diagnostic cohort study at Stepping Hill Hospital, United Kingdom. Patients
      presenting with chest pain of suspected cardiac nature warranting rule out for
      ACS were included. All patients underwent hs-cTnT testing at least 12h after peak
      symptoms. The primary outcome was a diagnosis of ACS, defined as either prevalent
      acute myocardial infarction (AMI) or incident major adverse cardiac events
      (death, AMI or coronary revascularization) within 30days. RESULTS: Of 405
      included patients, 76 (18.8%) had ACS. MACS and T-MACS had similar C-statistics
      (0.94 for each, p=0.36) and sensitivity (difference 1.3%, 95% CI -1.3 to 3.9%,
      p=1.00) but T-MACS had significantly greater specificity (difference 16.7%, 95%
      CI 14.6-18.9%, p<0.0001). T-MACS and MACS would have allowed 36.3% and 22.5%
      patients to be immediately discharged respectively. Of patients classified as
      'very low risk', none had ACS when MACS was used compared to one (0.7%) with
      T-MACS. CONCLUSION: Both MACS and T-MACS effectively ruled out ACS even with a
      contemporary troponin I assay and could be used to reduce unnecessary hospital
      admissions.
CI  - Copyright (c) 2017. Published by Elsevier Inc.
FAU - Va Den Berg, Patricia
AU  - Va Den Berg P
AD  - Maastricht University, Faculty of Health, Medicine & Life Sciences Maastricht
      University, Universiteitssingel, Maastricht, The Netherlands.
FAU - Burrows, Gillian
AU  - Burrows G
AD  - Stockport NHS Foundation Trust, Poplar Grove, Stockport, United Kingdom.
FAU - Lewis, Philip
AU  - Lewis P
AD  - Stockport NHS Foundation Trust, Poplar Grove, Stockport, United Kingdom.
FAU - Carley, Simon
AU  - Carley S
AD  - Central Manchester University Hospitals NHS Foundation Trust, Oxford Road,
      Manchester M13 9WL, United Kingdom; Manchester Metropolitan University, United
      Kingdom.
FAU - Body, Richard
AU  - Body R
AD  - Central Manchester University Hospitals NHS Foundation Trust, Oxford Road,
      Manchester M13 9WL, United Kingdom; Manchester Metropolitan University, United
      Kingdom; The University of Manchester, Manchester Academic Health Science Centre,
      Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address:
      richard.body@manchester.ac.uk.
LA  - eng
GR  - PDF-2012-05-193/Department of Health/United Kingdom
PT  - Journal Article
PT  - Validation Studies
DEP - 20170923
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Biomarkers)
RN  - 0 (Fatty Acid-Binding Proteins)
RN  - 0 (Troponin T)
SB  - IM
MH  - Acute Coronary Syndrome/*diagnosis/physiopathology
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers/blood
MH  - Chest Pain/diagnosis
MH  - *Decision Support Techniques
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Fatty Acid-Binding Proteins/blood
MH  - Female
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Troponin T/*blood
MH  - United Kingdom
OTO - NOTNLM
OT  - Acute coronary syndromes
OT  - Cardiac troponin
OT  - Clinical decision rules
OT  - Sensitivity and specificity
EDAT- 2017/10/29 06:00
MHDA- 2018/11/24 06:00
CRDT- 2017/10/29 06:00
PHST- 2017/08/11 00:00 [received]
PHST- 2017/09/13 00:00 [revised]
PHST- 2017/09/16 00:00 [accepted]
PHST- 2017/10/29 06:00 [pubmed]
PHST- 2018/11/24 06:00 [medline]
PHST- 2017/10/29 06:00 [entrez]
AID - S0735-6757(17)30757-X [pii]
AID - 10.1016/j.ajem.2017.09.032 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2018 Apr;36(4):602-607. doi: 10.1016/j.ajem.2017.09.032. Epub
      2017 Sep 23.