Several decision aids can ‘rule in’ and ‘rule out’ acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG.
We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded clinical features at the time of arrival using a bespoke form. Patients underwent serial troponin sampling and 30-day follow-up for the primary outcome of ACS. The model was derived by logistic regression in one cohort and validated in two similar prospective studies.
The HE-MACS model was derived in 796 patients and validated in cohorts of 474 and 659 patients. HE-MACS incorporated age, sex, systolic blood pressure plus five historical variables to stratify patients into four risk groups. On validation, 5.5 and 12.1% (pooled total 9.4%) patients were identified as ‘very low risk’ (potential immediate rule out) with a pooled sensitivity of 99.5% (95% confidence interval: 97.1–100.0%).
Using only the patient’s history and ECG, HE-MACS could ‘rule out’ ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings.
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aCardioavascular Science Research Group, Division of Cardiovascular Sciences The University of Manchester
bPostgraduate Medical School, Manchester Metropolitan University
cEmergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
dEmergency Department, St George’s University Hospitals NHS Foundation Trust, London, UK
eEmergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Correspondence to Abdulrhman Alghamdi, Msc, Cardioavascular Science Research Group, The University of Manchester, Grafton Street, Manchester M13 9PL, UK Tel: +44 7491 942 853; e-mail: firstname.lastname@example.org
Received March 20, 2018
Accepted August 22, 2018