T-MACS Troponin-Only Manchester ACS Decision Aid
Single time-point decision aid using high-sensitivity troponin T and 5 clinical variables to rule in or rule out AMI at presentation. Validated prospectively in multiple cohorts. Avoids the need for 3-hour serial troponin in very-low-risk patients.
Score interpretation
All clinical criteria absent AND hsTnT under 5 ng/L — AMI probability under 2%
→ Early discharge with outpatient review within 72 hours; aspirin; return precautions given. Do NOT apply rule-out if any clinical criterion is positive or hsTnT is 5 ng/L or above.
At least 1 clinical criterion present OR hsTnT 5 to 200 ng/L — serial measurement required
→ 0h and 3h serial hsTnT; if delta under 5 ng/L and peak under 52 ng/L: consider discharge with outpatient review; if delta 5 or above or rising: admit; HEART score risk stratification; cardiology consultation; continuous monitoring
hsTnT above 200 ng/L — AMI highly probable; immediate treatment required
→ Admit immediately; DAPT loading (aspirin 300 mg plus ticagrelor 180 mg); anticoagulation (LMWH or UFH); urgent cardiology review; coronary angiography if NSTEMI with ongoing ischaemia or haemodynamic compromise; STEMI pathway if ST elevation
Interpretation bands for the T-MACS. Apply clinical judgement and local guidance.
References
- Body R et al. T-MACS decision aid: single biomarker re-derivation and external validation in three cohorts. Emerg Med J. 2017;34(6):349-356.
Related
Curated clinical cross-links plus same-class fallbacks.
- HEART Score for Major Adverse Cardiac Events · Chest Pain
- EDACS — Emergency Department Assessment of Chest Pain · Chest Pain
- HEAR Score for Acute Chest Pain · Chest Pain
- ACTION ICU Score for Intensive Care in NSTEMI · Chest Pain
- Marburg Heart Score · Chest Pain
- INTERCHEST Clinical Prediction Rule · Chest Pain
- Terbinafine 1% Topical · Topical antifungal (allylamine)
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Progestogen-Only Pill (POP / Mini-pill) · Progestogen-Only Contraceptive (Oral)
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Lamivudine with tenofovir disoproxil and doravirine · NRTI/NRTI/NNRTI single-tablet regimen
- 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.