ToolsCalculators
Vancouver Chest Pain Rule
2-hour rule-out for early discharge of low-risk emergency department chest pain.
Vancouver Chest Pain Rule
Ischemic ECG changes (new, not known to be old)
Initial (0h) troponin above the 99th percentile
2-hour troponin above the 99th percentile
Chest pain fully reproducible by palpation
Age <40 years
Known coronary artery disease (prior MI, PCI, CABG, or angina)
Pain radiates to neck, jaw, or either arm
Diaphoresis witnessed with this episode
Pain is part of an accelerating/worsening pattern
ResultNot low risk
Does not satisfy either low-risk pathway; consider further risk stratification.
When to use
- Deciding whether a patient with possible ischemic chest pain can be safely discharged after 2 hours of ED evaluation without further provocative testing.
Formula
Decision rule (not a summed score): safe for early discharge if either (a) age <40, no known CAD, no typical radiation, no diaphoresis, non-worsening pattern, plus a normal ECG and negative 0h/2h troponin, or (b) chest pain fully reproducible by palpation plus a normal ECG and negative 0h/2h troponin.
Pearls and pitfalls
- Designed to identify a low-risk subgroup safe for outpatient follow-up, not to rule in ACS.
- Any ischemic ECG change or troponin elevation overrides both low-risk pathways.