title: Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Department of Emergency Medicine,Singapore General Hospital,Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.affiliation: †Division of Research,Singapore General Hospital,Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Hao
authors.affiliation: *Department of Emergency Medicine,Singapore General Hospital,Singapore.
authors.forename: Susan
authors.initials: S
authors.lastname: Yap
authors.affiliation: *Department of Emergency Medicine,Singapore General Hospital,Singapore.
authors.forename: Pin Pin
authors.initials: PP
authors.lastname: Pek
authors.affiliation: ‡National Heart Centre Singapore,Singapore General Hospital,Singapore.
authors.forename: Terrance Siang Jin
authors.initials: TS
authors.lastname: Chua
authors.affiliation: **Department of Ophthalmology,Tan Tock Seng Hospital,Singapore.
authors.forename: Faith Suan Peng
authors.initials: FS
authors.lastname: Ng
authors.affiliation: *Department of Emergency Medicine,Singapore General Hospital,Singapore.
authors.forename: Swee Han
authors.initials: SH
authors.lastname: Lim
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000367:Age Factors; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001774:Blood Chemical Analysis; D001955:British Columbia; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D010351:Patient Discharge / Q000592:standards*; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014505:Urban Population
keywords: Vancouver Chest Pain Rule; acute coronary syndrome; chest pain; clinical decision rules; emergency department