Value of Manchester Acute Coronary Syndromes Decision Rule in the Detection of Acute Coronary Syndrome; a Systematic
Fatemeh Ramezani1, Sajjad Ahmadi2, Gholamreza Faridaalee3
1Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Insights
The Manchester Acute Coronary Syndromes (MACS) decision rule effectively rules out acute myocardial infarction (AMI) and major adverse cardiac events (MACE). This systematic review confirms its diagnostic value, though further validation in developing countries is recommended.
Area of Science:
- Cardiology
- Diagnostic Accuracy
- Clinical Decision Rules
Background:
- The diagnostic value of the Manchester Acute Coronary Syndromes (MACS) decision rule for acute coronary syndrome (ACS) remains debated.
- Existing evidence requires synthesis to clarify MACS's role in clinical practice.
Purpose of the Study:
- To systematically review and meta-analyze the clinical evidence evaluating the diagnostic accuracy of the MACS decision rule for ACS.
- To summarize the performance of MACS in ruling out acute myocardial infarction (AMI) and major adverse cardiac events (MACE).
Main Methods:
- A comprehensive literature search was conducted across Medline, Embase, Scopus, and Web of Science databases.
- Data from 8 included studies were analyzed using STATA 14.0.
- Outcomes including AMI and MACE were assessed using summary receiver operating characteristic (SROC) curves, sensitivity, specificity, and likelihood ratios.
Main Results:
- The MACS decision rule demonstrated excellent areas under the SROC curve for ruling out AMI (AUC=0.99) and MACE (AUC=0.97).
- High sensitivity (0.99) was observed for ruling out AMI with both original MACS and troponin-only/HE-MACS variants.
- Specificity varied, with original MACS at 0.26 and troponin-only/HE-MACS at 0.22 for AMI rule-out.
Conclusions:
- The original MACS, troponin-only MACS, and History Electrocardiogram-MACS (HE-MACS) are effective in ruling out AMI and MACE.
- Further research is necessary to confirm the external validity of these findings in developing countries.
Introduction:
There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS.
Methods:
A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI).
Results:
Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.95 to 0.98). The sensitivity and specificity of the troponin-only MACS/history electrocardiogram alone MACS (HE-MACS) in the rule out of AMI were0.99 (95% CI: 0.98-0.99) and 0.22 (95% CI: 0.11-0.37), respectively, and for the original MACS were in order 0.99 (95% CI: 0.98-0.99) and 0.26 (95% CI: 0.20-0.34),. The sensitivity and specificity of the troponin-only MACS / HE-MACS in the rule out of MACE were 0.94 (95% CI: 0.92-0.96) and 0.22 (95% CI: 0.12-0.39) compared to the 0.99 (95% CI: 0.98-0.99) and 0.27 (95% CI: 0.22-0.33) for the original MACS.
Conclusion:
The findings of this study showed that original MACS, troponin-only MACS, and HE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity.
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