Performance of Manchester Acute Coronary Syndromes decision rules in acute coronary syndrome: a systematic review and meta-analysis.

IF 3.1 4区 医学 Q1 EMERGENCY MEDICINE
European Journal of Emergency Medicine Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI:10.1097/MEJ.0000000000001147
Shayan Roshdi Dizaji, Koohyar Ahmadzadeh, Hamed Zarei, Reza Miri, Mahmoud Yousefifard
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引用次数: 0

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). For MACE detection, MACS demonstrates a sensitivity of 98% (CI: 94-100), specificity of 22% (CI: 10-42), and AUC of 0.804 (CI: 0.659-0.897). T-MACS displays a sensitivity of 96% (CI: 94-98), specificity of 36% (CI: 30-43), and AUC of 0.792 (CI: 0.748-0.830). HE-MACS maintains a sensitivity of 99% (CI: 97-99), specificity of 10% (CI 6-16), and AUC of 0.713 (CI: 0.625-0.787). Of all the MACS models, T-MACS displayed the highest overall accuracy due to its high sensitivity and significantly superior specificity. T-MACS exhibits very good diagnostic performance in predicting both AMI and MACE. This makes it a highly promising tool for managing patients with acute chest pain.

曼彻斯特急性冠状动脉综合征决策规则在急性冠状动脉综合征中的表现:系统回顾和荟萃分析。
背景和重要性:目前有多种决策辅助模型可帮助医生识别急性冠状动脉综合征(ACS)并加速急诊科(ED)的决策过程:本研究评估了曼彻斯特急性冠状动脉综合征(MACS)规则及其衍生模型的诊断性能,为其临床应用提供了更多证据:设计:系统回顾和荟萃分析:对 Medline、Embase、Scopus 和 Web of Science 从开始到 2023 年 10 月的研究进行了检索,研究对象包括疑似心脏性胸痛和需要 ACS 风险分级的不确定结果的成人急诊室患者:MACS、仅肌钙蛋白MACS(T-MACS)或仅病史和心电图MACS(HE-MACS)决策辅助工具对诊断急性心肌梗死(AMI)的预测价值,以及因胸痛疑似ACS入院的急诊科患者的30天主要心脏不良结局(MACE)。使用 STATA 统计软件中的 "Diagma "软件包对总体灵敏度和特异性进行了综合分析。使用 QUADAS-2 工具对适用性和偏倚风险进行了评估:主要结果:对于急性心肌梗死的检测,MACS 的灵敏度为 99% [置信区间 (CI):97-100],特异性为 19% (CI:10-32),AUC 为 0.816 (CI:0.720-0.885)。T-MACS 的灵敏度为 98%(CI:98-99),特异性为 35%(CI:29-42),AUC 为 0.859(CI:0.824-0.887)。HE-MACS 的灵敏度为 99% (CI:98-100),特异性为 9% (CI:3-21),AUC 为 0.787 (CI:0.647-0.882)。在 MACE 检测方面,MACS 的灵敏度为 98% (CI:94-100),特异性为 22% (CI:10-42),AUC 为 0.804 (CI:0.659-0.897)。T-MACS 的灵敏度为 96% (CI:94-98),特异性为 36% (CI:30-43),AUC 为 0.792 (CI:0.748-0.830)。HE-MACS的灵敏度为99%(CI:97-99),特异性为10%(CI:6-16),AUC为0.713(CI:0.625-0.787):结论:在所有 MACS 模型中,T-MACS 的灵敏度高,特异性明显优于其他模型,因此总体准确性最高。T-MACS 在预测急性心肌梗死和心肌缺血方面表现出非常好的诊断性能。这使其成为管理急性胸痛患者的一种极具前景的工具。
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来源期刊
CiteScore
3.60
自引率
27.30%
发文量
180
审稿时长
6-12 weeks
期刊介绍: The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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