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dc.contributor.authorBody, R
dc.contributor.authorCarlton, E
dc.contributor.authorSperrin, M
dc.contributor.authorLewis, PS
dc.contributor.authorBurrows, G
dc.contributor.authorCarley, S
dc.contributor.authorMcDowell, G
dc.contributor.authorBuchan, I
dc.contributor.authorGreaves, K
dc.contributor.authorMackway-Jones, K
dc.date.accessioned2021-10-07T03:26:24Z
dc.date.available2021-10-07T03:26:24Z
dc.date.issued2017
dc.identifier.issn1472-0205
dc.identifier.doi10.1136/emermed-2016-205983
dc.identifier.urihttp://hdl.handle.net/10072/408710
dc.description.abstractBackground: 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. Methods: 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). Results: 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). Conclusions: 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.
dc.description.peerreviewedYes
dc.languageeng
dc.publisherBMJ Publishing Group
dc.relation.ispartofpagefrom349
dc.relation.ispartofpageto356
dc.relation.ispartofissue6
dc.relation.ispartofjournalEmergency Medicine Journal
dc.relation.ispartofvolume34
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchNursing
dc.subject.fieldofresearchHealth services and systems
dc.subject.fieldofresearchPublic health
dc.subject.fieldofresearchcode3202
dc.subject.fieldofresearchcode4205
dc.subject.fieldofresearchcode4203
dc.subject.fieldofresearchcode4206
dc.subject.keywordsacute myocardial infarct
dc.subject.keywordscardiac care, diagnosis
dc.subject.keywordsdiagnosis
dc.titleTroponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: Single biomarker re-derivation and external validation in three cohorts
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationBody, R; Carlton, E; Sperrin, M; Lewis, PS; Burrows, G; Carley, S; McDowell, G; Buchan, I; Greaves, K; Mackway-Jones, K, Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: Single biomarker re-derivation and external validation in three cohorts, Emergency Medicine Journal, 2017, 34 (6), pp. 349-356
dcterms.dateAccepted2016-07-05
dc.date.updated2021-10-07T03:24:01Z
gro.hasfulltextNo Full Text
gro.griffith.authorGreaves, Kim


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