Clinical Evaluation 
Clinical Data 
Biomarker Development and Validation
Current diagnostic methods for acute coronary syndromes lack sensitivity and specificity at the time of presentation to the Emergency Department.
The MACS and T-MACS rule has been developed using information available at the time of first presentation and the results from a single blood test for cardiac troponin. Initial evaluation demonstrated that the MACS rule could enable safe discharge of around a quarter of patients. The MACS rule also enabled he identification of high risk patients, facilitating a stratified approach to patient management.
The rule has been further refined and validated using point of care troponin testing as part of the Beside Evaluation of Troponin (BEST) Study
MACS and T-MACS Publications
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.
The rapid turnaround time of point of care (POC) cardiac troponin (cTn) assays is highly attractive for crowded Emergency Departments (EDs). We evaluated the diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a POC cTn assay.
Body, R., Carlton, E., Sperrin, M., Lewis, P.S., Burrows, G., Carley, S., McDowell, G., Buchan, I., Greaves, K. & Mackway-Jones, K. (2017). Troponin only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts. Emerg Med J 34 pp. 349-356
Background
The original Manchester Acute Coronary Syndromes model (MACS) ‘rules in’ and ‘out’ acute coronary syndromes (ACS) using high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (H-FABP) measured at admission. The latter is not always available. We aimed to refine and validate MACS as T-MACS, cutting down the biomarkers to just hs-cTnT.
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