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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.
The importance of BRCA1 and BRCA2 genes stems from the fact that they are 'caretaker' cancer-susceptibility genes, which encode molecules that act as sensors of DNA defects and participate in the repair process. The main function of BRCA2 is its role in HR-mediated DNA DSB repair through its direct interaction with RAD51. Most ovarian cancers occur sporadically, although approximately 10% of patients report an associated family history of the disease. In unselected series, about 6-15% of ovarian cancers have been found to be due to BRCA mutations. The ability to predict an individual's cancer risk accurately is limited by the influence of factors other than whether a BRCA1 or BRCA2 mutation has been inherited. The demonstration of single-agent anti-tumour activity and the wide therapeutic index of PARP inhibitors in BRCA1 and BRCA2 mutation carriers with advanced ovarian and breast cancers provide strong evidence for the clinical application of this approach.
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