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.

View at publisher

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.

Impact and interest:

13 citations in Scopus
Search Google Scholar™
11 citations in Web of Science®

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

ID Code: 88614
Item Type: Journal Article
Refereed: Yes
DOI: 10.1016/j.ajem.2013.10.021
ISSN: 0735-6757
Divisions: Current > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Deposited On: 05 Nov 2015 03:45
Last Modified: 05 Nov 2015 03:45

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page