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Am J Emerg Med. 2014 Feb;32(2):129-34. doi: 10.1016/j.ajem.2013.10.021. Epub 2013 Oct 14.

The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study.

Author information

1
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia. Electronic address: louise_cullen@health.qld.gov.au.
2
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
3
Department of Emergency Medicine, Christchurch Hospital, New Zealand.
4
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
5
School of Medicine, The University of Queensland, Brisbane, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
6
Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
7
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.

Abstract

OBJECTIVES:

To externally evaluate the accuracy of the new Vancouver Chest Pain Rule and to assess the diagnostic accuracy using either sensitive or highly sensitive troponin assays.

METHODS:

Prospectively collected data from 2 emergency departments (EDs) in Australia and New Zealand were analysed. Based on the new Vancouver Chest Pain Rule, low-risk patients were identified using electrocardiogram results, cardiac history, nitrate use, age, pain characteristics and troponin results at 2 hours after presentation. The primary outcome was 30-day diagnosis of acute coronary syndrome (ACS), including acute myocardial infarction, and unstable angina. Sensitivity, specificity, positive predictive values and negative predictive values were calculated to assess the accuracy of the new Vancouver Chest Pain Rule using either sensitive or highly sensitive troponin assay results.

RESULTS:

Of the 1635 patients, 20.4% had an ACS diagnosis at 30 days. Using the highly sensitive troponin assay, 212 (13.0%) patients were eligible for early discharge with 3 patients (1.4%) diagnosed with ACS. Sensitivity was 99.1% (95% CI 97.4-99.7), specificity was 16.1 (95% CI 14.2-18.2), positive predictive values was 23.3 (95% CI 21.1-25.5) and negative predictive values was 98.6 (95% CI 95.9-99.5). The diagnostic accuracy of the rule was similar using the sensitive troponin assay.

CONCLUSIONS:

The new Vancouver Chest Pain Rule should be used for the identification of low risk patients presenting to EDs with symptoms of possible ACS, and will reduce the proportion of patients requiring lengthy assessment; however we recommend further outpatient investigation for coronary artery disease in patients identified as low risk.

PMID:
24238485
DOI:
10.1016/j.ajem.2013.10.021
[Indexed for MEDLINE]

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