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

Cullen, Louise, Greenslade, Jaimi H., Than, Martin, Brown, Anthony F.T., Hammett, Christopher J., Lamanna, Arvin, Flaws, Dylan F., Chu, Kevin, Fowles, Lindsay F., & Parsonage, William A. (2014) The new Vancouver Chest Pain Rule using troponin as the only biomarker: An external validation study. American Journal of Emergency Medicine, 32(2), pp. 129-134.

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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.


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.


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.


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.

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19 citations in Scopus
17 citations in Web of Science®
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ID Code: 88614
Item Type: Journal Article
Refereed: Yes
DOI: 10.1016/j.ajem.2013.10.021
ISSN: 0735-6757
Divisions: Past > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Deposited On: 05 Nov 2015 03:45
Last Modified: 25 Jun 2017 20:02

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