{"id":136,"date":"2017-12-22T21:17:49","date_gmt":"2017-12-22T21:17:49","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=136"},"modified":"2019-01-19T09:26:29","modified_gmt":"2019-01-19T09:26:29","slug":"t-macs","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=136","title":{"rendered":"T-MACS"},"content":{"rendered":"

Body, R., Carlton, E., Sperrin, M., Lewis, P.S., Burrows, G., Carley, S., McDowell, G<\/strong>., 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<\/strong>. Emerg Med J 34 pp. 349-356<\/p>\n

\"\"<\/p>\n

Background<\/strong><\/p>\n

The original Manchester Acute Coronary Syndromes model (MACS) \u2018rules in\u2019 and \u2018out\u2019 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.<\/p>\n

\u00a0<\/p>\n

Methods<\/strong><\/p>\n

We present secondary analyses from four prospective diagnostic cohort studies including patients presenting to the Emergency Department (ED) with suspected ACS. Data were collected and hs-cTnT measured on arrival. The primary outcome was ACS, defined as prevalent acute myocardial infarction (AMI) or incident death, AMI or coronary revascularization within 30 days. T-MACS was built in one cohort (derivation set) and validated in three external cohorts (validation set).<\/p>\n

\u00a0<\/p>\n

Results<\/strong><\/p>\n

At the \u2018rule out\u2019 threshold, in the derivation set (n=703) T-MACS had 99.3% (95% CI 97.3\u201399.9%) negative predictive value (NPV) and 98.7% (95.3\u201399.8%) sensitivity for ACS, \u2018ruling out\u2019 37.7% patients (specificity 47.6%, positive predictive value 34.0%). In the validation set (n=1,459), T-MACS had 99.3% (98.3\u201399.8%) NPV and 98.1% (95.2\u201399.5%) sensitivity, \u2018ruling out\u2019 40.4% (n=590) patients (specificity 47.0%, positive predictive value 23.9%). T-MACS would \u2018rule in\u2019 10.1% and 4.7% patients<\/p>\n

in the respective sets, of which 100.0% and 91.3% had ACS. C-statistics for the original and refined rules were similar (T-MACS 0.91 vs. MACS 0.90 on validation).<\/p>\n

\u00a0<\/p>\n

Conclusions<\/strong><\/p>\n

T-MACS could \u2018rule out\u2019 ACS in 40% of patients while \u2018ruling in\u2019 5% at highest risk using a single hscTnT measurement on arrival. As a clinical decision aid, T-MACS could therefore help to conserve healthcare resources.<\/p>\n\nFull Text<\/span><\/a><\/span><\/span>","protected":false},"excerpt":{"rendered":"

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.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-2c","jetpack-related-posts":[{"id":568,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=568","url_meta":{"origin":136,"position":0},"title":"T-MACS and POCT Troponin","date":"January 17, 2019","format":false,"excerpt":"The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid for rapid rule-in and rule-out of acute coronary syndromes using a contemporary point of care troponin assay Richard Body; Malak Almashali; Niall Morris; Phil Moss; Heather Jarman; Andrew Appelboam; Richard Parris; Louisa Chan; Alison Walker; Mark Harrison; Andrea Wootten; Garry McDowellc\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":531,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=531","url_meta":{"origin":136,"position":1},"title":"Manchester Acute Coronary Syndrome Rule (MACS & T-MACS)","date":"January 19, 2019","format":false,"excerpt":"Clinical EvaluationClinical DataBiomarker Development and Validation Current diagnostic methods for acute coronary syndromes lack sensitivity and specificity at the time of presentation to the Emergency Department. 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