Value of Manchester Acute Coronary Syndromes Decision Rule in the Detection of Acute Coronary Syndrome; a Systematic Review and MetaAnalysis

Introduction: 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 metaanalyzes is to summarize the clinical evidence in the evaluation of  the value of MACS in the diagnosis of ACS.Methods: 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).Results: Finally, 8 articles included in the metaanalysis. 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 troponinonly MACS/history electrocardiogram alone MACS (HEMACS) in the rule out of AMI were0.99 (95% CI: 0.980.99) and 0.22 (95% CI: 0.110.37), respectively, and for  the original MACS were in order 0.99 (95% CI: 0.980.99) and 0.26 (95% CI: 0.200.34),. The sensitivity and specificity of the troponinonly MACS / HEMACS in the rule out of MACE were 0.94 (95% CI: 0.920.96) and 0.22 (95% CI: 0.120.39) compared to the 0.99 (95% CI: 0.980.99) and 0.27 (95% CI: 0.220.33) for the original MACS.Conclusion: The findings of this study showed that original MACS, troponinonly MACS, and HEMACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity.