{"id":659,"date":"2019-02-07T18:50:47","date_gmt":"2019-02-07T18:50:47","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=659"},"modified":"2019-02-07T18:50:48","modified_gmt":"2019-02-07T18:50:48","slug":"macs-rule","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=659","title":{"rendered":"MACS Rule"},"content":{"rendered":"\n

Body, R., Carley, S., McDowell, G<\/strong>., 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. <\/p>\n\n\n\n

Objective:<\/strong>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.<\/p>\n\n\n\n

Methods:<\/strong>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 (\u03ba>0.6) univariate predictors ( p<0.05) for inclusion. <\/p>\n\n\n\n

Results:<\/strong>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 \u2018very low risk\u2019 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 \u2018high-risk\u2019, 95.7% of whom developed MACE.<\/p>\n\n\n\n

Conclusions:<\/strong>The Manchester Acute Coronary Syndromes (MACS) rule has the potential to safely reduce unnecessary hospital admissions and facilitate judicious use of high dependency resources.<\/p>\n\n\nFull Text<\/span><\/a>","protected":false},"excerpt":{"rendered":"

Body, R., Carley, S., McDowell, 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.  Objective:We<\/p>\n","protected":false},"author":1,"featured_media":592,"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-aD","jetpack-related-posts":[{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":659,"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":136,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=136","url_meta":{"origin":659,"position":1},"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":629,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=629","url_meta":{"origin":659,"position":2},"title":"Risk Factors and AMI","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G.,Carley, S. & Mackway-Jones, K. (2008) \u2018Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the emergency department.\u2019\u00a0Resuscitation79 pp. 41-45.\u00a0 Background:Hypertension, hyperlipidaemia, diabetes mellitus, tobacco smoking and a family history of premature coronary artery disease are known to be risk factors for the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Risk-factors-for-ED-diagnosis-e1549807935709.png?fit=400%2C313&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":637,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=637","url_meta":{"origin":659,"position":3},"title":"Symptoms and Signs in ACS","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S., Wibberley, C.,\u00a0McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes.\u2019\u00a0Resuscitation81 pp. 281-286.\u00a0 Objective:Patient history and physical examination are widely accepted as cornerstones of diagnosis in modern medicine. We aimed to assess the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Symptoms-and-Signs-e1549807905811.png?fit=400%2C311&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":641,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=641","url_meta":{"origin":659,"position":4},"title":"A FABP-ulous rule out strategy","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Wibberley, C., Ferguson, J. & Mackway-Jones, K. (2011) \u2018A FABP-ulous rule out strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction.\u2019\u00a0Resuscitation82 pp. 1041-1046.\u00a0 Objective:Many Emergency Departments (EDs) utilise \u2018triple marker\u2019 testing with CK-MB, myoglobin and troponin I (cTnI) to\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Quanti-HFABP-e1549807872944.png?fit=400%2C341&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":531,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=531","url_meta":{"origin":659,"position":5},"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":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/659"}],"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=659"}],"version-history":[{"count":2,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/659\/revisions"}],"predecessor-version":[{"id":662,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/659\/revisions\/662"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/media\/592"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=659"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}