Performance of Manchester Acute Coronary Syndromes decision rules in acute coronary syndrome: a systematic review and meta-analysis
Abstract
Multiple decision-aiding models are available to help physicians identify acute coronary syndrome (ACS) and accelerate the decision-making process in emergency departments (EDs). This study evaluated the diagnostic performance of the Manchester Acute Coronary Syndrome (MACS) rule and its derivations, enhancing the evidence for their clinical use. A systematic review and meta-analysis was performed. Medline, Embase, Scopus, and Web of Science were searched from inception until October 2023 for studies including adult ED patients with suspected cardiac chest pain and inconclusive findings requiring ACS risk-stratification. The predictive value of MACS, Troponin-only MACS (T-MACS), or History and Electrocardiogram-only MACS (HE-MACS) decision aids for diagnosing acute myocardial infarction (AMI) and 30-day major adverse cardiac outcomes (MACEs) among patients admitted to ED with chest pain suspected of ACS. Overall sensitivity and specificity were synthesized using the ‘Diagma’ package in STATA statistical software. Applicability and risk of bias assessment were performed using the QUADAS-2 tool. For AMI detection, MACS has a sensitivity of 99% [confidence interval (CI): 97–100], specificity of 19% (CI: 10–32), and AUC of 0.816 (CI: 0.720–0.885). T-MACS shows a sensitivity of 98% (CI: 98–99), specificity of 35% (CI: 29–42), and AUC of 0.859 (CI: 0.824–0.887). HE-MACS exhibits a sensitivity of 99% (CI: 98–100), specificity of 9% (CI: 3–21), and AUC of 0.787 (CI: 0.647–0.882).…
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