Validating the Manchester Acute Coronary Syndromes (MACS) Clinical Decision Rule

Diagnosis of heart attack (acute myocardial infarction) relies on troponin testing along with additional inpatient investigations. Researchers in the United Kingdom have developed a clinical decision rule (the MACS rule) for avoiding unnecessary hospitalisation for patients with chest pain. The MACS rule places individuals into four risk groups with suggested dispositions for each group, with the very low risk eligible for immediate discharge. Initial validation of the rule revealed that 31.5% of patients met the low risk criteria and so could be discharged from hospital with no further investigation. Of these patients, none had a heart attack within 30 days.
This study will conduct an external validation of the MACS rule using a sample of 1000 patients who presented to the Royal Brisbane and Women’s Hospital emergency department with chest pain. If the MACS rule accuracy identifies a group of patients who do not have a heart attack, it could be used in clinical care to rapidly rule out heart attack, decrease resource utilisation and ensure that patients are not subjected to unnecessary testing in hospital.