Cardiology · Emergency Medicine

History and ECG-only Manchester Acute Coronary Syndromes calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

Age

years

Allowed range: 0–120 years

Age enters the equation as 0.024 times age in years.

Sex

Male sex adds its coefficient. Female sex does not.

Sweating observed

Acute ischaemic changes on the ECG

ST deviation or abnormal T-wave inversion read as acute. Fixed changes known not to be acute are coded no.

Pain radiating to the right arm or shoulder

Vomiting with the pain

Systolic blood pressure

mmHg

Allowed range: 40–260 mmHg

Systolic pressure under 100 mmHg adds its coefficient. A value of 100 does not.

Current tobacco smoker

Result

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Primary source

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. DOI: 10.1097/MEJ.0000000000000575. PMID: 30289775. Table 2 logistic model: sweating observed 1.426, acute ECG ischaemia 1.838, pain radiating to the right arm or shoulder 0.734, vomiting with pain 0.996, systolic pressure under 100 mmHg 1.353, current tobacco smoker 0.675, age in years 0.024, male sex 0.462, constant −4.416. Probability = 1 / (1 + e^−(linear predictor)). The supplement sets very low risk under 4%, low risk 4% through 6.9%, moderate risk 7.0% through 49.9%, and high risk 50% or higher. Acute ischaemia is the treating clinician's reading and includes ST deviation and abnormal T inversion; fixed changes known not to be acute are coded absent. (2019)

Scope: Adults in the emergency department or before hospital arrival with suspected cardiac chest pain, when a history and ECG are available and a biomarker has not yet been used.

Last reviewed 2026-10-17

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Professional use only

For qualified clinicians. Independently verify inputs, calculations, source guidance, and applicability before any clinical action. This calculator does not replace clinical judgment.

Source: 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. DOI: 10.1097/MEJ.0000000000000575. PMID: 30289775. Table 2 logistic model: sweating observed 1.426, acute ECG ischaemia 1.838, pain radiating to the right arm or shoulder 0.734, vomiting with pain 0.996, systolic pressure under 100 mmHg 1.353, current tobacco smoker 0.675, age in years 0.024, male sex 0.462, constant −4.416. Probability = 1 / (1 + e^−(linear predictor)). The supplement sets very low risk under 4%, low risk 4% through 6.9%, moderate risk 7.0% through 49.9%, and high risk 50% or higher. Acute ischaemia is the treating clinician's reading and includes ST deviation and abnormal T inversion; fixed changes known not to be acute are coded absent. (2019)

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Clinical inputs

Age (years)Accepted range: 0 to 120
Sex
Sweating observed
Acute ischaemic changes on the ECG
Pain radiating to the right arm or shoulder
Vomiting with the pain
Systolic blood pressure (mmHg)Accepted range: 40 to 260
Current tobacco smoker

Primary source

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