{"id":568,"date":"2019-01-17T21:40:36","date_gmt":"2019-01-17T21:40:36","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=568"},"modified":"2019-01-19T09:27:17","modified_gmt":"2019-01-19T09:27:17","slug":"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","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=568","title":{"rendered":"T-MACS and POCT Troponin"},"content":{"rendered":"\n

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

Richard Body; Malak Almashali; Niall Morris; Phil Moss; Heather Jarman; Andrew Appelboam; Richard Parris; Louisa Chan; Alison Walker; Mark Harrison; Andrea Wootten; Garry McDowellc<\/sup><\/p>\n\n\n\n

Objectives<\/h3>\n\n\n\n

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. <\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

In a prospective diagnostic accuracy study at 8 EDs, we included patients with suspected acute coronary syndromes (ACS). Blood drawn on arrival and 3 hours later was analysed for POC cTnI (i-Stat, Abbott Point of Care). The primary outcome was a diagnosis of ACS, which included both an adjudicated diagnosis of acute myocardial infarction (AMI) based on serial laboratory cTn testing and major adverse cardiac events (death, AMI or coronary revascularization) within 30 days.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

Of 716 patients included, 105 (14.7%) had ACS. Using serial POC cTnI concentrations over 3 hours could have \u2018ruled out\u2019 ACS in 198 (31.2%) patients with a sensitivity of 99.0% (95% CI 94.4 \u2013 100.0%) and negative predictive value 99.5% (95% CI 96.5 \u2013 99.9%). No AMIs were missed. T-MACS \u2018ruled in\u2019 ACS for 65 (10.4%) patients with a positive predictive value of 91.2% (95% CI 82.1 \u2013 95.9%) and specificity 98.9% (97.6 \u2013 99.6%).<\/p>\n\n\n\n

Conclusion <\/h3>\n\n\n\n

With a POC cTnI assay, T-MACS could \u2018rule out\u2019 ACS for approximately one third of patients within 3 hours while \u2018ruling in\u2019 ACS for another 10%. The rapid turnaround time and portability of the POC assay make this an attractive pathway for use in crowded EDs or urgent care centres. Future work should also evaluate use in the pre-hospital environment.<\/p>\n\n\nLink to Publisher<\/span><\/a>\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

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;<\/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-9a","jetpack-related-posts":[{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":568,"position":0},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\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":568,"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. 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\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Research-Papers-Pages-1.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":136,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=136","url_meta":{"origin":568,"position":2},"title":"T-MACS","date":"December 22, 2017","format":false,"excerpt":"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\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages-300x200.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":121,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=121","url_meta":{"origin":568,"position":3},"title":"Research Papers","date":"December 22, 2017","format":false,"excerpt":"Body, R., McDowell, G., Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019 Emerg Med J. 27 pp. 292-296. Body, R., Carley, S., Wibberley, C., McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":732,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=732","url_meta":{"origin":568,"position":4},"title":"Novel hs-cTn Assay with a Single Serum Test in ED.","date":"July 21, 2019","format":false,"excerpt":"3D illustration of Heart - Part of Human Organic. Objectives To evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the Emergency Department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals.\u00a0 Methods\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/07\/Screenshot-2019-07-21-at-10.53.34-e1563702957497.png?fit=364%2C500&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":659,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=659","url_meta":{"origin":568,"position":5},"title":"MACS Rule","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Pemberton, P., Burrows, G., Cook, G., Lewis, P.S., Smith, A., Mackway-Jones, K. (2014) \u2018The Manchester Acute Coronary Syndromes (MACS) decision rule for suspected cardiac chest pain: derivation and external validation.\u2019 Heart 100 pp. 1462-1468.\u00a0 Objective:We aimed to derive and validate a clinical decision rule (CDR)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/MACS-Paper-e1549807711724.png?fit=400%2C331&resize=350%2C200","width":350,"height":200},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/568"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=568"}],"version-history":[{"count":4,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/568\/revisions"}],"predecessor-version":[{"id":579,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/568\/revisions\/579"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=568"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}