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Research letter
Prehospital T-MACS and HEART scores in the prediction of myocardial infarction: a prospective evaluation
  1. Jamie G Cooper1,2,
  2. Lorna A Donaldson3,
  3. Amanda J Coutts1,
  4. Richard Body4,5,
  5. Nicholas L Mills6,7
  1. 1 Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
  2. 2 School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
  3. 3 Scottish Ambulance Service, Edinburgh, UK
  4. 4 Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
  5. 5 Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  6. 6 BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  7. 7 Usher Institute, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Jamie G Cooper, Emergency Department, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; jamie.cooper2{at}nhs.scot

https://doi.org/10.1136/emermed-2023-213639

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    Chest pain suspicious for an acute myocardial infarction (MI) is a common reason for emergency ambulance contact. Most patients have a non-diagnostic ECG and transport to hospital for troponin testing is the rule. In the emergency department, tools such as the troponin-only Manchester acute coronary syndrome (T-MACS) decision aid1 and the HEART (history, ECG, age, risk factors and troponin) score2 are used to identify those at low risk of MI for consideration of early discharge. Recently, the history and ECG-only Manchester acute coronary syndrome (HE-MACS) decision aid3 and the HEAR (history, ECG, age and risk factors) score4 have been developed, aiming to identify low-risk patients without troponin testing. We previously demonstrated the feasibility of paramedics using the HEAR and HEART scores,5 6 but performance did not enable a safe rule out of MI in this setting. Whether the T-MACS or HE-MACS tools would perform better and enable paramedics to manage low-risk patients without hospital transfer is uncertain.

    The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS) was performed in northeast Scotland.5 Patients with chest pain suspicious for MI were approached by study-trained paramedics. A subset of the study population provided contemporaneous prehospital data for HEAR and HEART scores, HE-MACS and T-MACS (online supplemental material) and had blood drawn for later testing with the Abbott ARCHITECTSTAT high-sensitivity cardiac troponin I assay. This assay has a limit of detection (LOD) …

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    Footnotes

    • Handling editor Edward Carlton

    • Twitter @JamieCooperEM, @richardbody

    • Contributors JGC and RB conceived the study and its design. JGC, LAD and AJC acquired the data. JGC performed the analysis. JGC, RB and NLM interpreted the data. JGC, RB and NLM drafted the manuscript. All authors reviewed the manuscript critically for intellectually important content and provided their final approval of the version to be submitted. All authors are accountable for the work. JGC is the guarantor.

    • Funding The study was supported financially by the Digital Health & Care Institute (DHI) (reference DHI/MCADAM), Scotland and by the NHS Grampian Endowment Fund (grant number N0042903) and the University of Aberdeen contributed to the design and administration of the study. The funders had no role in study design, data collection, or interpretation, or the writing of the report. JGC was supported by a NHS Research Scotland Clinical Research Fellowship. NLM is supported by the British Heart Foundation through a Chair Award, Programme Grant and Research Excellence Award (CH/F/21/90010, RG/20/10/34966, RE/18/5/34216).

    • Competing interests RB has undertaken consultancy with Roche, Abbott, Siemens, Beckman Coulter, Radiometer, Aptamer Group and LumiraDx, has recent research grants with Abbott Point of Care and Siemens and has conducted research involving donation of reagents by Roche, all unrelated to this work. NLM has received research grants to the University of Edinburgh, and honoraria or consultancy from Abbott Diagnostics, Roche Diagnostics, Siemens Healthineers and LumiraDx that are unrelated to this work. None of the other authors have any competing interests to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.