Value of Manchester Acute Coronary Syndromes DecisionRule in the Detection of Acute Coronary Syndrome; a Sys-tematic Review and Meta-Analysis

There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) deci-sion rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic reviewand meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagno-sis of ACS.

A literature search was performed on the Medline, Embase, Scopus, and Web of Sciencedatabases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE).Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver op-erating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic oddsratio with 95% confidence interval (95% CI).

Finally, 8 articles included in the meta-analysis. The areaunder the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC= 0.97, 95% CI: 0.95 to 0.98). The sensitivity and specificity of the troponin-only MACS / history electrocardio-gram alone MACS (HE-MACS) in the rule out of AMI were 0.99 (95% CI: 0.98-0.99) and 0.22 (95% CI: 0.11-0.37),respectively, and for the original MACS were in order 0.99 (95% CI: 0.98-0.99) and 0.26 (95% CI: 0.20-0.34). Thesensitivity and specificity of the troponin-only MACS / HE-MACS in the rule out of MACE were 0.94 (95% CI:0.92-0.96) and 0.22 (95% CI: 0.12-0.39) compared to the 0.99 (95% CI: 0.98-0.99) and 0.27 (95% CI: 0.22-0.33) forthe original MACS.

The findings of this study showed that original MACS, troponin-only MACS, andHE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries toconfirm its external validity.