History and Electrocardiogram-only Manchester Acute Coronary Syndromes (HE-MACS)
Stratifies ACS risk with history and EKG only (not yet externally validated).
Use in patients ≥18 years old presenting with suspected cardiac chest pain (symptoms within the last 24 hours).
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In patients who are “very low” risk, ACS is unlikely. Consider discharge without cardiac biomarkers, with caution, and consider further investigation in an ambulatory setting.
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“Very low” risk was <4.0% risk of ACS or MACE in 30 days, which was selected by the authors to achieve 100% sensitivity in the derivation cohort, and was subsequently found to be 99.5% sensitive (95% CI 97.1-100) in validation cohorts.
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In patients who are not “very low” risk, further workup is recommended.
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HE-MACS is a decision aid and not a definitive test that is designed to assist in the risk stratification of patients with chest pain. Clinical judgment should always be used.
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Where all the HE-MACS decision aid components are negative and a “very low” risk of ACS or 30-day MACE is identified, ACS is unlikely and discharge without cardiac biomarkers may be considered, with caution.