The use of T-MACS algorithm in elderly patients in acute cardiac care

Introduction: Chest pain is one of the leading causes for visit at the emergency department. Atypical symptoms, ambiguous laboratory and electrocardiographical findings in elderly make the rapid diagnostics difficult. Diagnostic algorithms were developed for effective risk stratification and they can direct us towards the right diagnosis and correct treatment.

Objective: The aim of this study is to evaluate the effectiveness of T-MACS algorithm in very old patients presenting with acute chest pain.

Methods: Retrospective analysis of 104 patients older than 80 years which were examined at emergency department for acute chest pain. Primary composite endpoint was combination of acute myocardial infarction, percutaneous coronary intervention (PCI) and all-cause death in 30 day and 12 months follow-up.

Results: Mean age of study population is 84.9 years. Risk stratification according to T-MACS model: very low risk 1 %, low risk 24 %, intermediate risk 69.2 % and high risk 5.8 % patients. In 30 days follow-up, the incidence of primary composite endpoint (MACE) was 26.9 %, acute myocardial infarction 26 %, PCI 7.7% and all-cause mortality was 1.9 %. Estimated risk of major adverse cardiac events in 30 days was 28 % (average T-MACS score). T-MACS < 2 % has 100 % sensitivity and 100 % negative predictive value for absence of MACE, T-MACS > 95 % has 98.7 % specificity and 83.3 % positive predictive value for occurrence of MACE respectively. Patients with MACE had significantly different T-MACS score (p value < 0.01) compared to patients without MACE, difference in levels of hs-TnT was not statistically significance (p value > 0.05).

Conclusion: We found good correlation between estimated and real incidence of selected cardiac events in our population. For the prediction of MACE the single value of hs-TnT is not good enough, more convenient is to use combination of more parameters. T-MACS has very high sensitivity and negative predictive value for absence of MACE and can be used in real world practice even in population of very old patients.

Keywords: chest pain, elderly, T-MACS.