Manchester Acute Coronary Syndromes (MACS) Rule of Body et al for a Patient with Acute Chest Pain

Patient selection: an adult in the Emergency Department (ED) with suspected cardiac chest pain

Outcome: 30-day major adverse cardiac event (MACE = death, acute myocardial infarction, need for coronary revascularization or new coronary stenosis > 50%)

Parameters:

(1) high sensitivity serum troponin T in ng/L (Roche Diagnostics)

(2) heart-type fatty acid binding protein (FABP) in ng/mL (Randox Evidence Investigator Cardiac Array)

(3) ECG ischemia

(4) sweating observed

(5) vomiting

(6) systolic blood pressure in mm Hg

(7) worsening angina

(8) pain radiating to the right arm or shoulder

X =

= SUM(points for all 8 parameters) - 4.83

probability of MACE =

= 1 / (1 + EXP((-1) * X))

Interpretation:

• A patient identified as very low risk may be considered for discharge from the ED.

Performance:

• The area under the ROC curve was 0.95.

Limitations:

• The heart-type fatty acid binding protein may not be readily available.