Feasibility of the Manchester Acute Coronary Syndromes (MACS) decision rule to safely reduce unnecessary hospital admissions: a pilot randomised controlled trial

Emergency Medicine Journal : EMJ
Richard BodyFiona E Lecky

Abstract

Observational studies suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule can effectively 'rule out' and 'rule in' acute coronary syndromes (ACS) following a single blood test. In a pilot randomised controlled trial, we aimed to determine whether a large trial is feasible. Patients presenting to two EDs with suspected cardiac chest pain were randomised to receive care guided by the MACS decision rule (intervention group) or standard care (controls). The primary efficacy outcome was a successful discharge from the ED, defined as a decision to discharge within 4 hours of arrival providing that the patient did not have a missed acute myocardial infarction (AMI) or develop a major adverse cardiac event (MACE: death, AMI or coronary revascularisation) within 30 days. Feasibility outcomes included recruitment and attrition rates. In total, 138 patients were included between October 2013 and October 2014, of whom 131 (95%) were randomised (66 to intervention and 65 controls). Nine (7%) patients had prevalent AMI and six (5%) had incident MACE within 30 days. All 131 patients completed 30-day follow-up and were included in the final analysis with no missing data for the primary analyses. Compared with standard car...Continue Reading

References

Aug 31, 2010·Critical Pathways in Cardiology·Barbra E BackusPieter A F M Doevendans
May 17, 2011·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Patrick FitzgeraldSimon Dixon
Sep 17, 2011·Journal of the American College of Cardiology·Richard BodyKevin Mackway-Jones
Apr 13, 2012·Circulation. Cardiovascular Quality and Outcomes·Erik P HessVictor M Montori
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Jan 24, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Edward CarltonKim Greaves

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Citations

Feb 22, 2018·Emergency Medicine Journal : EMJ·Simon Carley, Simon Laing
Jan 24, 2018·Emergency Medicine Journal : EMJ·Edward Carlton, Richard Body
Aug 17, 2019·Circulation·Martin P ThanUNKNOWN MI3 collaborative
Jul 23, 2020·Annals of Medicine·Harsh GoelGregory Y H Lip
Feb 27, 2021·Archives of Pathology & Laboratory Medicine·David N Alter
Sep 24, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Charles ReynardRichard Body

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