HE-MACS (History and ECG-only Manchester Acute Coronary Syndromes)
Probability of acute coronary syndrome from history, examination and ECG only — no troponin — to identify very-low-risk chest pain at triage. Derived and validated in UK emergency departments.
Score interpretation
HE-MACS very low risk: no ACS in the derivation cohort; pooled validation sensitivity 99.5 %.
→ Possible immediate rule-out only within a local pathway that has adopted HE-MACS; otherwise follow the local chest pain (troponin) pathway.
HE-MACS low risk.
→ Potentially suitable for ambulatory assessment with troponin testing per the local pathway.
HE-MACS moderate risk.
→ ED assessment with serial troponin per the local pathway.
HE-MACS high risk (potential rule-in).
→ Urgent senior / cardiology review; manage as possible ACS.
Interpretation bands for the HE-MACS. Apply clinical judgement and local guidance.
References
- Alghamdi A, et al. Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid. Eur J Emerg Med. 2019;26(5):356-361.
- Todd F, Duff J, Carlton E. Identifying low-risk chest pain in the emergency department without troponin testing: a validation study of the HE-MACS and HEAR risk scores. Emerg Med J. 2022;39(7):515-518.
Related
Curated clinical cross-links plus same-class fallbacks.
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Morphine (Orthopaedic Acute Pain) · Opioid Analgesic — Strong
- Dexketoprofen (Acute Musculoskeletal Pain) · NSAID — Non-selective COX Inhibitor (S-enantiomer of Ketoprofen)
- Colchicine (Pericarditis / Post-MI Inflammation) · Pericarditis / Coronary Inflammation
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.