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Background Accurate risk stratification in patients presenting with chest pain is crucial for timely and appropriate management. The Troponin-only Manchester Acute Coronary Syndromes (TMACS) score is a validated cardiac risk stratification tool used to rule acute coronary syndrome (ACS) in or out an ACS in acute care. It incorporates clinical factors and high-sensitivity cardiac troponin concentration, it aids in identifying patients at varying risk levels ACS. Identifying clinical pathways in which patients should be managed.Objective This study aims to evaluate the sensitivity of the TMACS score in the management, pathway of care and subsequent referral for any further cardiac investigations in the outpatient setting.Methods The study analysed 220 patients who had presented to a District General Hospital (DGH) over a six-month period to either the Emergency Department (ED) or Same Day Emergency Care (SDEC) with chest pain and were subsequently discharged and referred to cardiology for further outpatient follow-up and investigations if indicated. Patients were grouped into risk categories using the TMACS score. Patients presenting with chest pain were evaluated using the T-MACS score, which includes clinical criteria such as ischemia on ECG, worsening angina, pain radiating to the right arm, pain associated with vomiting, sweating, hypotension, and troponin levels. The risk categories—very low, low, moderate, and high—were used to guide further diagnostic testing and treatment. The outpatient cardiology management was analysed, this included waiting times and patient outcomes.Results Out of 220 patients, data for 2 patients were not available. The demographic data showed that 120 were males and 98 were females, with an age range of 24–91 and an average age of 59. The TMACS score revealed that 123 patients were at very low risk, 37 at low risk, 58 at moderate risk, and 1 at high risk. Additionally, 47 patients had typical chest pain, 170 had atypical chest pain, and 1 patient presented with palpitations. A total of 172 patients were referred to Same Day Emergency Care (SDEC) and 210 were referred to cardiology for further assessments. Only one patient had a revisit within the next three months. Utilisation of the TMACS score resulted in improved clinical outcomes and reduced unnecessary hospital admissions and diagnostic testing. Among the patients who were deemed as very low risk based on TMACS, a percentage were investigated further with a functional test in the outpatient setting.Conclusion The TMACS score is a valuable clinical tool for risk stratification in patients presenting with chest pain. Its use enhances clinical decision-making, optimises resource utilisation, and improves patient outcomes, making it an essential component of chest pain evaluation protocols.