Body, Richard, Carlton, Edward, Sperrin, Matthew, Lewis, Philip S, Burrows, Gillian, Carley, Simon, McDowell, Garry, Buchan, Iain 
ORCID: 0000-0003-3392-1650, Greaves, Kim and Mackway-Jones, Kevin
(2017)
Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts.
EMERGENCY MEDICINE JOURNAL, 34 (6).
349-+.
Abstract
<h4>Background</h4>The original Manchester Acute Coronary Syndromes model (MACS) 'rules in' and 'rules 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 Troponin-only Manchester Acute Coronary Syndromes (T-MACS), cutting down the biomarkers to just hs-cTnT.<h4>Methods</h4>We present secondary analyses from four prospective diagnostic cohort studies including patients presenting to the 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 revascularisation within 30 days. T-MACS was built in one cohort (derivation set) and validated in three external cohorts (validation set).<h4>Results</h4>At the 'rule out' threshold, in the derivation set (n=703), T-MACS had 99.3% (95% CI 97.3% to 99.9%) negative predictive value (NPV) and 98.7% (95.3%-99.8%) sensitivity for ACS, 'ruling out' 37.7% patients (specificity 47.6%, positive predictive value (PPV) 34.0%). In the validation set (n=1459), T-MACS had 99.3% (98.3%-99.8%) NPV and 98.1% (95.2%-99.5%) sensitivity, 'ruling out' 40.4% (n=590) patients (specificity 47.0%, PPV 23.9%). T-MACS would 'rule in' 10.1% and 4.7% patients 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).<h4>Conclusions</h4>T-MACS could 'rule out' ACS in 40% of patients, while 'ruling in' 5% at highest risk using a single hs-cTnT measurement on arrival. As a clinical decision aid, T-MACS could therefore help to conserve healthcare resources.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Troponin T, Prevalence, Logistic Models, Cohort Studies, Prospective Studies, Predictive Value of Tests, Decision Support Techniques, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Emergency Service, Hospital, Female, Male, Acute Coronary Syndrome, Biomarkers, Fatty Acid Binding Protein 3 |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 19 Mar 2019 16:14 |
| Last Modified: | 19 Jan 2023 00:56 |
| DOI: | 10.1136/emermed-2016-205983 |
| Open Access URL: | http://dx.doi.org/10.1136/emermed-2016-205983 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3034522 |
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