Ramezani Fatemeh, Ahmadi Sajjad, Faridaalee Gholamreza, Baratloo Alireza, Yousefifard Mahmoud
Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Emergency Medicine Department, Maragheh University of Medical Sciences; Maragheh; Iran.
Emerg (Tehran). 2018;6(1):e61. Epub 2018 Dec 15.
There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS.
A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. 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 operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI).
Finally, 8 articles included in the meta-analysis. The area under 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 electrocardiogram alone MACS (HE-MACS) in the rule out of AMI were0.99 (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),. The sensitivity 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) for the original MACS.
The findings of this study showed that original MACS, troponin-only MACS, and HE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity.
关于曼彻斯特急性冠状动脉综合征（MACS）决策规则在检测急性冠状动脉综合征（ACS）方面的价值，目前仍未达成共识。因此，本系统评价和荟萃分析的目的是总结评估MACS在ACS诊断中价值的临床证据。
在Medline、Embase、Scopus和Web of Science数据库中进行文献检索。结局指标包括急性心肌梗死（AMI）和主要不良心脏事件（MACE）。数据在STATA 14.0统计软件中进行分析，结果以汇总受试者工作特征曲线（SROC）、灵敏度、特异度、阳性和阴性似然比以及诊断比值比并伴有95%置信区间（95%CI）的形式报告。
最终，8篇文章纳入荟萃分析。MACS在排除AMI（AUC = 0.99，95%CI：0.97至0.99）和MACE（AUC = 0.97，95%CI：0.95至0.98）方面的SROC曲线下面积优异。仅肌钙蛋白MACS/仅病史心电图MACS（HE-MACS）在排除AMI时的灵敏度和特异度分别为0.99（95%CI：0.98 - 0.99）和0.22（95%CI：0.11 - 0.37），而原始MACS的灵敏度和特异度依次为0.99（95%CI：0.98 - 0.99）和0.26（95%CI：0.20 - 0.34）。仅肌钙蛋白MACS / HE-MACS在排除MACE时的灵敏度和特异度分别为0.94（95%CI：0.92 - 0.96）和0.22（95%CI：0.12 - 0.39），相比之下原始MACS的灵敏度和特异度分别为0.99（95%CI：0.98 - 0.99）和0.27（95%CI：0.22 - 0.33）。
本研究结果表明，原始MACS、仅肌钙蛋白MACS和HE-MACS能够排除AMI和MACE。然而，发展中国家需要进一步研究以证实其外部有效性。
