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T-MACS ACS probability

T-MACS

Compute the Body 2016 Troponin-only Manchester Acute Coronary Syndromes (T-MACS) logistic probability of ACS from caller-assigned ECG ischaemia, worsening angina, right-arm or shoulder radiation, vomiting, observed sweating, hypotension, and Roche Elecsys hs-cTnT in ng/L.

LIVE $0.005 USDC GET /api/calc/t_macs

Markdown: /docs/t-macs.md · Canonical: https://magentlab.com/docs/t-macs

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Compute the Body 2016 Troponin-only Manchester Acute Coronary Syndromes (T-MACS) logistic probability of ACS from caller-assigned ECG ischaemia, worsening angina, right-arm or shoulder radiation, vomiting, observed sweating, hypotension, and Roche Elecsys hs-cTnT in ng/L.

When to use

When an agent already has those Body 2016 predictors as assigned by the caller and needs the published T-MACS probability and risk band. magent does not interpret an ECG or assay troponin. Not a diagnosis, discharge protocol, or original MACS (H-FABP).

When not to use

  • Not a medical device. Not a diagnosis of ACS.
  • ecg_ischaemia, worsening_angina, pain_radiation_right_arm_or_shoulder, vomiting, sweating_observed, and hypotension are caller-assigned. magent does not interpret ECG ischaemia or assay troponin.
  • hs-cTnT is Roche Diagnostics Elecsys in ng/L as entered. 0–100000 ng/L is an implementation clamp. magent does not convert units.
  • Body 2016 rounded T-MACS coefficients only. Not original MACS (H-FABP). Not HEART. Not EDACS. Not the Vancouver Chest Pain Rule.
  • That paper writes low as 0.02<p<0.05 and moderate as 0.05<p<0.95 (equality at 0.02 and 0.05 omitted). magent uses a complete partition: p<0.02 very_low, 0.02≤p<0.05 low, 0.05≤p<0.95 moderate, p≥0.95 high. Bands use unrounded p.
  • The paper notes patients are only ruled out if all model features are absent and hs-cTnT is <10 ng/L. This tool returns the logistic probability; it does not add a second checklist gate.
  • Not a discharge, observation, or rule-out protocol.

Formula

p = 1/(1+e^(-λ)); λ = 1.713*E + 0.847*A + 0.607*R + 1.417*V + 2.058*S + 1.208*H + 0.089*T - 4.766; E ECG ischaemia 0/1; A worsening/crescendo angina 0/1; R right-arm/shoulder radiation 0/1; V vomiting 0/1; S sweating observed 0/1; H hypotension SBP<100 0/1; T Roche Elecsys hs-cTnT ng/L; very_low p<0.02, low 0.02<=p<0.05, moderate 0.05<=p<0.95, high p>=0.95 (Body 2016 rounded coefficients; paper writes 0.02<p<0.05 and 0.05<p<0.95)

Citation

Title
Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts
Authors
Body R, Carlton E, Sperrin M, et al.
Source
Emerg Med J. 2017;34(6):349-356
DOI
10.1136/emermed-2016-205983

Worked example

All dichotomous false, hs-cTnT 3 ng/L

Given: ecg_ischaemia=falsehs_ctnt_ng_l=3hypotension=falsepain_radiation_right_arm_or_shoulder=falsesweating_observed=falsevomiting=falseworsening_angina=false

  1. E=A=R=V=S=H=0; T=3
  2. λ = -4.766 + 0.089×3 = -4.499
  3. p = 1/(1+e^4.499) = 0.0110
  4. p<0.02 → very_low

Also searched as

  • T-MACS
  • troponin-only MACS
  • Troponin-only Manchester Acute Coronary Syndromes
  • Body T-MACS
  • Manchester ACS troponin
  • T MACS decision aid
  • hs-cTnT MACS

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/t_macs?ecg_ischaemia=false&worsening_angina=false&pain_radiation_right_arm_or_shoulder=false&vomiting=false&sweating_observed=false&hypotension=false&hs_ctnt_ng_l=3

Full URL: https://api.magentlab.com/api/calc/t_macs?ecg_ischaemia=false&worsening_angina=false&pain_radiation_right_arm_or_shoulder=false&vomiting=false&sweating_observed=false&hypotension=false&hs_ctnt_ng_l=3

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge. 

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/t_macs?ecg_ischaemia=false&worsening_angina=false&pain_radiation_right_arm_or_shoulder=false&vomiting=false&sweating_observed=false&hypotension=false&hs_ctnt_ng_l=3"

Parameters

Name Type Required Description
ecg_ischaemia boolean required Caller-assigned ECG ischaemia as used in Body 2016 (E; 1 if true, 0 if false). magent does not interpret an ECG.
worsening_angina boolean required Worsening or crescendo angina as assigned by the caller (A): anginal pain with increasing frequency, occurring with less exertion, or becoming more prolonged (Body 2016). true or false.
pain_radiation_right_arm_or_shoulder boolean required Pain radiating to the right arm or shoulder as assigned by the caller (R; Body 2016). true or false. magent does not take a pain history.
vomiting boolean required Vomiting in association with the presenting symptoms as assigned by the caller (V; Body 2016). true or false.
sweating_observed boolean required Sweating observed by the treating clinician as assigned by the caller (S; Body 2016). true or false. magent does not examine the patient.
hypotension boolean required Hypotension as assigned by the caller (H): systolic BP <100 mm Hg on arrival (Body 2016, dichotomised as in that paper). true or false.
hs_ctnt_ng_l number required Roche Diagnostics Elecsys high-sensitivity cardiac troponin T on arrival in ng/L (T; 0-100000, implementation clamp). Continuous linear predictor in Body 2016. magent does not convert units or assay troponin.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/t_macs Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

  • 1 to 25 items. Each item uses the same keys as the GET query parameters.
  • POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
  • The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
  • HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
  • Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
  • x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "ecg_ischaemia": "false",
      "hs_ctnt_ng_l": "3",
      "hypotension": "false",
      "pain_radiation_right_arm_or_shoulder": "false",
      "sweating_observed": "false",
      "vomiting": "false",
      "worsening_angina": "false"
    },
    {
      "ecg_ischaemia": "false",
      "hs_ctnt_ng_l": "3",
      "hypotension": "false",
      "pain_radiation_right_arm_or_shoulder": "false",
      "sweating_observed": "false",
      "vomiting": "false",
      "worsening_angina": "false"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/t_macs",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Body R, Carlton E, Sperrin M, et al.",
        "doi": "10.1136/emermed-2016-205983",
        "id": "body-2016",
        "pmid": "27565197",
        "source": "Emerg Med J. 2017;34(6):349-356",
        "title": "Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts"
      },
      "formula": "t_macs",
      "formula_expression": "p = 1/(1+e^(-λ)); λ = 1.713*E + 0.847*A + 0.607*R + 1.417*V + 2.058*S + 1.208*H + 0.089*T - 4.766; E ECG ischaemia 0/1; A worsening/crescendo angina 0/1; R right-arm/shoulder radiation 0/1; V vomiting 0/1; S sweating observed 0/1; H hypotension SBP<100 0/1; T Roche Elecsys hs-cTnT ng/L; very_low p<0.02, low 0.02<=p<0.05, moderate 0.05<=p<0.95, high p>=0.95 (Body 2016 rounded coefficients; paper writes 0.02<p<0.05 and 0.05<p<0.95)",
      "vomiting": false,
      "hypotension": false,
      "linear_predictor": -4.499,
      "probability": 0.011,
      "ecg_ischaemia": false,
      "hs_ctnt_ng_l": 3.0,
      "pain_radiation_right_arm_or_shoulder": false,
      "sweating_observed": false,
      "t_macs_band": "very_low",
      "worsening_angina": false
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Body R, Carlton E, Sperrin M, et al.",
        "doi": "10.1136/emermed-2016-205983",
        "id": "body-2016",
        "pmid": "27565197",
        "source": "Emerg Med J. 2017;34(6):349-356",
        "title": "Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts"
      },
      "formula": "t_macs",
      "formula_expression": "p = 1/(1+e^(-λ)); λ = 1.713*E + 0.847*A + 0.607*R + 1.417*V + 2.058*S + 1.208*H + 0.089*T - 4.766; E ECG ischaemia 0/1; A worsening/crescendo angina 0/1; R right-arm/shoulder radiation 0/1; V vomiting 0/1; S sweating observed 0/1; H hypotension SBP<100 0/1; T Roche Elecsys hs-cTnT ng/L; very_low p<0.02, low 0.02<=p<0.05, moderate 0.05<=p<0.95, high p>=0.95 (Body 2016 rounded coefficients; paper writes 0.02<p<0.05 and 0.05<p<0.95)",
      "vomiting": false,
      "hypotension": false,
      "linear_predictor": -4.499,
      "probability": 0.011,
      "ecg_ischaemia": false,
      "hs_ctnt_ng_l": 3.0,
      "pain_radiation_right_arm_or_shoulder": false,
      "sweating_observed": false,
      "t_macs_band": "very_low",
      "worsening_angina": false
    }
  ]
}

Response

Field Type Description
formula string t_macs
formula_expression string Body 2016 rounded T-MACS logistic expression
ecg_ischaemia boolean Caller-assigned ECG ischaemia used as E
worsening_angina boolean Caller-assigned worsening/crescendo angina used as A
pain_radiation_right_arm_or_shoulder boolean Caller-assigned right-arm or shoulder radiation used as R
vomiting boolean Caller-assigned vomiting used as V
sweating_observed boolean Caller-assigned observed sweating used as S
hypotension boolean Caller-assigned hypotension (SBP <100 mm Hg) used as H
hs_ctnt_ng_l number Roche Elecsys hs-cTnT used as T, in ng/L
linear_predictor number Body 2016 λ from the rounded coefficients, 4 decimals
probability number p = 1/(1+e^(-λ)) on 0-1, 4 decimals. Banded on unrounded p.
t_macs_band string very_low (p<0.02, ACS ruled out in that paper), low (0.02≤p<0.05), moderate (0.05≤p<0.95), or high (p≥0.95, ACS ruled in). Not a diagnosis.
citation object Body 2016/2017 EMJ citation
disclaimer string Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup. 

{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Body R, Carlton E, Sperrin M, et al.",
    "doi": "10.1136/emermed-2016-205983",
    "id": "body-2016",
    "pmid": "27565197",
    "source": "Emerg Med J. 2017;34(6):349-356",
    "title": "Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts"
  },
  "formula": "t_macs",
  "formula_expression": "p = 1/(1+e^(-λ)); λ = 1.713*E + 0.847*A + 0.607*R + 1.417*V + 2.058*S + 1.208*H + 0.089*T - 4.766; E ECG ischaemia 0/1; A worsening/crescendo angina 0/1; R right-arm/shoulder radiation 0/1; V vomiting 0/1; S sweating observed 0/1; H hypotension SBP<100 0/1; T Roche Elecsys hs-cTnT ng/L; very_low p<0.02, low 0.02<=p<0.05, moderate 0.05<=p<0.95, high p>=0.95 (Body 2016 rounded coefficients; paper writes 0.02<p<0.05 and 0.05<p<0.95)",
  "vomiting": false,
  "hypotension": false,
  "linear_predictor": -4.499,
  "probability": 0.011,
  "ecg_ischaemia": false,
  "hs_ctnt_ng_l": 3.0,
  "pain_radiation_right_arm_or_shoulder": false,
  "sweating_observed": false,
  "t_macs_band": "very_low",
  "worsening_angina": false
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP Code When
400 invalid_t_macs T-MACS inputs must match Body 2016 dichotomous predictors and Roche hs-cTnT ng/L from that paper. Returned before settlement; you are not charged.
400 invalid_items POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400 invalid_item_count items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400 invalid_item each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

  • HEART score — Compute the HEART score as age points plus caller-assigned history, ECG, risk factors, and troponin (each 0-2).
  • EDACS — Compute the Than 2014 Emergency Department Assessment of Chest pain Score from age, sex, and caller-assigned flags.
  • Vancouver Chest Pain Rule — Apply the Christenson 2006 Vancouver Chest Pain Rule derivation tree and return whether caller-assigned ECG, 2-hour troponin, prior ACS or nitrate, palpation, age, and radiation nodes are early-discharge eligible.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

  • HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
  • exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
  • HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
  • Execution is timeout-bounded and concurrency-capped.
  • Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.