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    Patent Pending

    Troponin-only Manchester Acute Coronary Syndromes (T-MACS) Decision Aid

    Rules out acute coronary syndrome.
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    When to Use
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    Why Use

    Patients with chest pain that may be cardiac in nature.

    • The T-MACS Decision Aid predicts acute coronary syndrome (ACS) or 30-day major adverse cardiac events (MACE) in patients with suspected cardiac chest pain.
    • 30-day MACE was defined as acute myocardial infarction (AMI), death, or coronary revascularization.
    • Uses high sensitivity cardiac troponin T (hs-cTnT), along with subjective symptoms and objective signs to risk stratify chest pain patients with suspected cardiac chest pain.
    • Uses a single hs-cTnT measurement on arrival, not serial values like other chest pain scores.
    • Inclusion and exclusion criteria differed slightly between the derivation and validation sets, e.g. chest pain within 12 vs. 24 hours of onset; age limits 16 vs. 18 vs. 25 years old.

    Point to Keep in Mind:

    • Remember, hs-cTNT is also a low-specificity troponin. While it may suggest ACS in high-risk patients, it can be elevated for many other reasons besides acute coronary syndromes. See Evidence for differential diagnoses.
    • Can essentially rule OUT ACS in very low risk patients.
    • Can essentially rule IN ACS in high risk patients.
    • Can avoid costly hospital admissions or risk of harm from invasive tests in patients predicted not to have ACS or risk of 30-day MACE.
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    Critical Actions

    • T-MACS is a decision aid and not a definitive test. It is designed to assist in the workup of a patient’s chest pain. Clinical judgment should always be used.
    • If all the components of the T-MACS decision aid are negative, ACS can essentially be ruled out without having to calculate the score.
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    Dr. Richard Body
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