Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

• Published in: Canadian journal of emergency medicine Vol. 19; no. 1; p. 18
• Main Authors: Ong, Marcus Eng Hock, Hao, Ying, Yap, Susan, Pek, Pin Pin, Chua, Terrance Siang Jin, Ng, Faith Suan Peng, Lim, Swee Han
• Format: Journal Article
• Language: English
• Published: England 01-01-2017
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Adult; Age Factors; Aged; Asian Continental Ancestry Group - statistics & numerical data; Blood Chemical Analysis; British Columbia; Chest Pain - diagnosis; Chest Pain - mortality; Chest Pain - therapy; Chi-Square Distribution; Cohort Studies; Electrocardiography - methods; Emergency Service, Hospital - standards; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Patient Discharge - standards; Prospective Studies; Risk Assessment; Sex Factors; Statistics, Nonparametric; Urban Population; acute coronary syndrome; Vancouver Chest Pain Rule; clinical decision rules; emergency department; chest pain
• ISSN: 1481-8035
• DOI: 10.1017/cem.2016.336

The new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED.
This prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment.
The study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%.
We found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events.