TROPONIN ONLY MANCHESTER ACUTE CORONARY SYNDROME(T-MAC) SCORE AS A DIAGNOSTIC TOOL OF ACUTE CORONARY SYNDROME IN THE EMERGENCY DEPARTMENT.

Abstract

Chest pain is one of the most common presenting complaints in the Emergency Department(ED).We aimed to apply Troponin only-Manchester Acute Coronary(T-MAC) Score as a diagnostic risk stratication to 'rule in' and 'rule out' Acute Coronary Syndrome(ACS) at triage. Methods: This study was undertaken in the Emergency Department of a tertiary care Hospital. A sample size of 50 patients presenting with acute chest pain were evaluated and assigned a probability of ACS using the T-MAC rule, electrocardigraphy(ECG) ndings, contemporary Troponin-I levels and clinical symptoms. As per the rule, patients were stratied into low risk, moderate risk and high risk. Results: Of the 50 patients who presented with chest pain in the ED with a male:female ratio of 2.5:1, ~22% were High Risk patients and were sent for immediate intervention to the Cardiac care unit,~70% were Moderate risk patients, they were admitted to the ward for further evaluation and intervention, ~8% were Low risk patients and were discharged after a period of 24 Hrs observation. Out of the 50 patients, 1 patient was discharged against medical advice. The ROC analysis found under AUC(Area under curve) is 0.964 with p<0.05, with cut off value for TMAC study is 4. Conclusions: With the ROC analysis found under AUC of 0.964, the TMAC Score can be applied as a good tool for evaluation of chest pain patients and as an aid in the clinical judgement for the diagnosis of Acute Coronary Syndrome in the Emergency Department