ACS - risk stratification - Revision history

Danbot: Strip excess bold text

2026-03-22T09:23:53Z

Strip excess bold text

← Older revision		Revision as of 09:23, 22 March 2026
Line 6:		Line 6:
	*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>		*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>
	*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen L et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>		*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen L et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>
	*With ~~'''~~high sensitivity troponins~~'''~~ the ~~'''~~sensitivity is 99.1%~~'''~~ (95% CI 97.4-99.7), & ~~'''~~specificity is 16.1~~'''~~ (95% CI 14.2-18.2)		*With high sensitivity troponins the sensitivity is 99.1% (95% CI 97.4-99.7), & specificity is 16.1 (95% CI 14.2-18.2)
	*With ~~'''~~sensitive troponin-I~~'''~~ the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)		*With sensitive troponin-I the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)

	===Algorithm===		===Algorithm===
	*Is the same for c-TnI assay and hs-TnI assay but sensitivity differences by a percentage point		*Is the same for c-TnI assay and hs-TnI assay but sensitivity differences by a percentage point
	#~~'''~~Is there an abnormal ECG, positive [[troponin]] at 2 hrs or prior ACS nitrate use?~~'''~~		#Is there an abnormal ECG, positive [[troponin]] at 2 hrs or prior ACS nitrate use?
	#*If ''Yes'' to any then no early discharge		#*If ''Yes'' to any then no early discharge
	#~~'''~~Does palpation reproduce the pain?~~'''~~		#Does palpation reproduce the pain?
	#*If ''Yes'' then early discharge		#*If ''Yes'' then early discharge
	#~~'''~~Age ≥50, or does pain radiate to neck, jaw, or left arm?~~'''~~		#Age ≥50, or does pain radiate to neck, jaw, or left arm?
	#*If ''Yes'' then no early discharge		#*If ''Yes'' then no early discharge

Danbot: Danbot moved page ACS - Risk Stratification to ACS - risk stratification: Naming convention: first word capitalized, subsequent words lowercase

2026-03-22T02:37:11Z

Danbot moved page ACS - Risk Stratification to ACS - risk stratification: Naming convention: first word capitalized, subsequent words lowercase

← Older revision	Revision as of 02:37, 22 March 2026
(No difference)

Ostermayer at 03:29, 26 April 2017

2017-04-26T03:29:40Z

@@ Line 1: / Line 1: @@
 ==HEART Score==
-*The score has been derived and validated in an ED population and predicts 6 week adverse cardiac events<ref>Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6.PMID 18665203</ref><ref>Backus BE, Six AJ, Kelder JC, Bosschaert MA. et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8 PMID 2346525</ref>
+{{HEART Score}}
 ==New Vancouver Chest Pain Rule==

Neil.m.young: Reverted edits by Neil.m.young (talk) to last revision by Rossdonaldson1

2017-03-01T16:18:24Z

Reverted edits by Neil.m.young (talk) to last revision by Rossdonaldson1

← Older revision		Revision as of 16:18, 1 March 2017
Line 55:		Line 55:
	*Useful for screening patient with low risk for ACS		*Useful for screening patient with low risk for ACS
	*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>		*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>
	*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen ~~left~~ et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>		*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen L et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>
	*With '''high sensitivity troponins''' the '''sensitivity is 99.1%''' (95% CI 97.4-99.7), & '''specificity is 16.1''' (95% CI 14.2-18.2)		*With '''high sensitivity troponins''' the '''sensitivity is 99.1%''' (95% CI 97.4-99.7), & '''specificity is 16.1''' (95% CI 14.2-18.2)
	*With '''sensitive troponin-I''' the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)		*With '''sensitive troponin-I''' the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)

Neil.m.young: Text replacement - " L " to " left "

2017-02-28T00:22:10Z

Text replacement - " L " to " left "

← Older revision		Revision as of 00:22, 28 February 2017
Line 55:		Line 55:
	*Useful for screening patient with low risk for ACS		*Useful for screening patient with low risk for ACS
	*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>		*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>
	*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen L et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>		*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen left et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>
	*With '''high sensitivity troponins''' the '''sensitivity is 99.1%''' (95% CI 97.4-99.7), & '''specificity is 16.1''' (95% CI 14.2-18.2)		*With '''high sensitivity troponins''' the '''sensitivity is 99.1%''' (95% CI 97.4-99.7), & '''specificity is 16.1''' (95% CI 14.2-18.2)
	*With '''sensitive troponin-I''' the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)		*With '''sensitive troponin-I''' the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)

Rossdonaldson1: Text replacement - "<" to "<"

2017-01-23T22:14:59Z

Text replacement - "<" to "<"

Rossdonaldson1: Text replacement - ">" to ">"

2017-01-23T20:48:04Z

Text replacement - ">" to ">"

Rossdonaldson1: Text replacement - "troponin " to "troponin "

2016-12-04T14:53:14Z

Text replacement - "troponin " to "troponin "

Neil.m.young: Text replacement - " ==" to "=="

2016-08-03T23:09:17Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 23:09, 3 August 2016
Line 172:		Line 172:
	{{TIMI Score}}		{{TIMI Score}}

	==See Also ==		==See Also==
	*[[Acute Coronary Syndrome (Main)]]		*[[Acute Coronary Syndrome (Main)]]
	*[[EBQ:ADAPT_Trial_2-Hour_Troponin_Rule_Out\|ADAPT Trial]]		*[[EBQ:ADAPT_Trial_2-Hour_Troponin_Rule_Out\|ADAPT Trial]]

Neil.m.young: Text replacement - "followup" to "follow-up"

2016-07-13T14:43:54Z

Text replacement - "followup" to "follow-up"

← Older revision		Revision as of 14:43, 13 July 2016
Line 48:		Line 48:
	\| ≤ normal limit\|\|0		\| ≤ normal limit\|\|0
	\|}		\|}
	*'''0-3''': 2.5% risk of adverse cardiac event. Patient's can be discharged with ~~followup~~.		*'''0-3''': 2.5% risk of adverse cardiac event. Patient's can be discharged with follow-up.
	*'''4-6''': 20.3% risk of adverse cardiac event. Patients should be admitted to the hospital for trending of troponin and provocative testing.		*'''4-6''': 20.3% risk of adverse cardiac event. Patients should be admitted to the hospital for trending of troponin and provocative testing.
	*'''≥7''': 72.7% risk of adverse cardiac event, suggesting early invasive measures with these patients and close coordination with inpatient cardiology		*'''≥7''': 72.7% risk of adverse cardiac event, suggesting early invasive measures with these patients and close coordination with inpatient cardiology
Line 68:		Line 68:
	#*If ''Yes'' then no early discharge		#*If ''Yes'' then no early discharge

	*If answer is ''No'' to all of the above stepwise questions then the patient can have early discharge with close ~~followup~~ for further provocative testing		*If answer is ''No'' to all of the above stepwise questions then the patient can have early discharge with close follow-up for further provocative testing

	==Likelihood That Signs/Symptoms Represent ACS due to CAD==		==Likelihood That Signs/Symptoms Represent ACS due to CAD==

← Older revision		Revision as of 22:14, 23 January 2017
Line 99:		Line 99:
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" \| New, or presumably new, transient ST-segment deviation (1 mm or greater) or T-wave inversion in multiple precordial leads		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" \| New, or presumably new, transient ST-segment deviation (1 mm or greater) or T-wave inversion in multiple precordial leads
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Fixed Q waves		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Fixed Q waves
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| T-wave flattening or inversion ~~<~~1 mm in leads with dominant R waves		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| T-wave flattening or inversion <1 mm in leads with dominant R waves
	\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"		\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| ST depression 0.5–1.0 mm or T-wave inversion >1 mm		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| ST depression 0.5–1.0 mm or T-wave inversion >1 mm
Line 156:		Line 156:
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| ECG		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| ECG
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Angina at rest with transient ST-segment changes >0.5 mm		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Angina at rest with transient ST-segment changes >0.5 mm
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| T-wave changes, pathologic Q waves, or resting ST depression ~~<~~1 mm in multiple lead groups (anterior, inferior, lateral)		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| T-wave changes, pathologic Q waves, or resting ST depression <1 mm in multiple lead groups (anterior, inferior, lateral)
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal or unchanged ECG		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal or unchanged ECG
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
Line 165:		Line 165:
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Cardiac markers		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Cardiac markers
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Elevated cardiac TnT, TnI, or CK-MB (e.g., TnT or TnI >0.1 nanogram/mL)		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Elevated cardiac TnT, TnI, or CK-MB (e.g., TnT or TnI >0.1 nanogram/mL)
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Slightly elevated cardiac TnT, TnI, or CK-MB (e.g., TnT >0.01 but ~~<~~0.1 nanogram/mL)		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Slightly elevated cardiac TnT, TnI, or CK-MB (e.g., TnT >0.01 but <0.1 nanogram/mL)
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal
	\|}		\|}

← Older revision		Revision as of 20:48, 23 January 2017
Line 84:		Line 84:
	\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"		\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" \| Known history of coronary artery disease, including myocardial infarction		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" \| Known history of coronary artery disease, including myocardial infarction
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Age ~~>~~70 y old		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Age >70 y old
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" \| Recent cocaine use		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" \| Recent cocaine use
	\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"		\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
Line 101:		Line 101:
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| T-wave flattening or inversion <1 mm in leads with dominant R waves		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| T-wave flattening or inversion <1 mm in leads with dominant R waves
	\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"		\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| ST depression 0.5–1.0 mm or T-wave inversion ~~>~~1 mm		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" \| ST depression 0.5–1.0 mm or T-wave inversion >1 mm
	\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"		\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Normal ECG		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Normal ECG
Line 127:		Line 127:
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Character of the pain		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Character of the pain
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Prolonged ongoing (~~>~~20 min) rest pain		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Prolonged ongoing (>20 min) rest pain
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Prolonged (~~>~~20 min) rest angina, now resolved, with moderate or high likelihood of CAD		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Prolonged (>20 min) rest angina, now resolved, with moderate or high likelihood of CAD
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Increased angina frequency, severity, or duration		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Increased angina frequency, severity, or duration
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Rest angina (~~>~~20 min) or relieved with rest or sublingual nitroglycerin		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Rest angina (>20 min) or relieved with rest or sublingual nitroglycerin
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Angina provoked at a lower threshold		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Angina provoked at a lower threshold
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
Line 138:		Line 138:
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Nocturnal angina		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Nocturnal angina
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| New-onset or progressive Canadian Cardiology Society Class III or IV angina in the past 2 wk without prolonged (~~>~~20 min) rest pain but with intermediate or high likelihood of CAD;		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| New-onset or progressive Canadian Cardiology Society Class III or IV angina in the past 2 wk without prolonged (>20 min) rest pain but with intermediate or high likelihood of CAD;
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \|		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \|
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Clinical findings		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Clinical findings
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Pulmonary edema, most likely due to ischemia		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Pulmonary edema, most likely due to ischemia
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Age ~~>~~70 y old		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Age >70 y old
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Chest discomfort reproduced by palpation		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="5" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Chest discomfort reproduced by palpation
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
Line 152:		Line 152:
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Hypotension, bradycardia, tachycardia		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Hypotension, bradycardia, tachycardia
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Age ~~>~~75 y old		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Age >75 y old
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| ECG		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| ECG
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Angina at rest with transient ST-segment changes ~~>~~0.5 mm		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Angina at rest with transient ST-segment changes >0.5 mm
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| T-wave changes, pathologic Q waves, or resting ST depression <1 mm in multiple lead groups (anterior, inferior, lateral)		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| T-wave changes, pathologic Q waves, or resting ST depression <1 mm in multiple lead groups (anterior, inferior, lateral)
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal or unchanged ECG		\| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal or unchanged ECG
Line 164:		Line 164:
	\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"		\|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Cardiac markers		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Cardiac markers
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Elevated cardiac TnT, TnI, or CK-MB (e.g., TnT or TnI ~~>~~0.1 nanogram/mL)		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Elevated cardiac TnT, TnI, or CK-MB (e.g., TnT or TnI >0.1 nanogram/mL)
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Slightly elevated cardiac TnT, TnI, or CK-MB (e.g., TnT ~~>~~0.01 but <0.1 nanogram/mL)		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Slightly elevated cardiac TnT, TnI, or CK-MB (e.g., TnT >0.01 but <0.1 nanogram/mL)
	\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal		\| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" \| Normal
	\|}		\|}

← Older revision		Revision as of 14:53, 4 December 2016
Line 49:		Line 49:
	\|}		\|}
	*'''0-3''': 2.5% risk of adverse cardiac event. Patient's can be discharged with follow-up.		*'''0-3''': 2.5% risk of adverse cardiac event. Patient's can be discharged with follow-up.
	*'''4-6''': 20.3% risk of adverse cardiac event. Patients should be admitted to the hospital for trending of troponin and provocative testing.		*'''4-6''': 20.3% risk of adverse cardiac event. Patients should be admitted to the hospital for trending of [[troponin]] and provocative testing.
	*'''≥7''': 72.7% risk of adverse cardiac event, suggesting early invasive measures with these patients and close coordination with inpatient cardiology		*'''≥7''': 72.7% risk of adverse cardiac event, suggesting early invasive measures with these patients and close coordination with inpatient cardiology

Line 55:		Line 55:
	*Useful for screening patient with low risk for ACS		*Useful for screening patient with low risk for ACS
	*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>		*The old Vancouver chest pain rule was not properly validated<ref name="Vancouver Validation">Jalili M. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012 Jul;19(7):837-42.</ref><ref name="Vancouver Original">Christenson J. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006 Jan;47(1):1-10. </ref> <ref name="Vancouver Original"></ref>
	*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen L et al. The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>		*The new rule was validated in 2014 on 1635 patients and published in 2014<ref>Cullen L et al. The new Vancouver Chest Pain Rule using [[troponin]] as the only biomarker: an external validation study. Am J Emerg Med. 2014 Feb;32(2):129-34</ref>
	*With '''high sensitivity troponins''' the '''sensitivity is 99.1%''' (95% CI 97.4-99.7), & '''specificity is 16.1''' (95% CI 14.2-18.2)		*With '''high sensitivity troponins''' the '''sensitivity is 99.1%''' (95% CI 97.4-99.7), & '''specificity is 16.1''' (95% CI 14.2-18.2)
	*With '''sensitive troponin-I''' the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)		*With '''sensitive troponin-I''' the sensitivity was 98.8% (97.0-99.5), & specificity of 15.8 (13.9-17.9)
Line 61:		Line 61:
	===Algorithm===		===Algorithm===
	*Is the same for c-TnI assay and hs-TnI assay but sensitivity differences by a percentage point		*Is the same for c-TnI assay and hs-TnI assay but sensitivity differences by a percentage point
	#'''Is there an abnormal ECG, positive troponin at 2 hrs or prior ACS nitrate use?'''		#'''Is there an abnormal ECG, positive [[troponin]] at 2 hrs or prior ACS nitrate use?'''
	#*If ''Yes'' to any then no early discharge		#*If ''Yes'' to any then no early discharge
	#'''Does palpation reproduce the pain?'''		#'''Does palpation reproduce the pain?'''
Line 106:		Line 106:
	\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"		\|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Cardiac markers		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Cardiac markers
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Elevated cardiac troponin I, troponin T, or MB fraction of creatine kinase		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Elevated cardiac [[troponin]] I, [[troponin]] T, or MB fraction of creatine kinase
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Normal		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Normal
	\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Normal		\| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" \| Normal