Diamond and Forrester Chest Pain Prediction Rule

Aka: Diamond and Forrester Chest Pain Prediction Rule

1. See Also
   1. Chest Pain
   2. Acute Chest Pain Approach
   3. Angina Diagnosis
   4. Cardiac Risk Assessment
   5. Cardiac Risk Management
   6. TIMI Risk Score
   7. Bosner Chest Pain Decision Rule
   8. Cardiac Risk in Diabetes Score
   9. Chest Wall Pain Prediction Rule
   10. Framingham Score
   11. HEART Score
   12. GRACE Score
   13. Vancouver Chest Pain Rule
2. Criteria
   1. Substernal Chest Pain
   2. Exertional Chest Pain
   3. Chest Pain relieved with rest
3. Interpretation
   1. Typical Angina: 3 criteria from above
      1. Age 30-39: 76% likelihood (intermediate) in men and 26% in women (intermediate)
      2. Age 40-49: 87% likelihood (high) in men and 55% in women (intermediate)
      3. Age 50-59: 93% likelihood (high) in men and 73% in women (intermediate)
      4. Age 60-69: 94% likelihood (high) in men and 86% in women (high)
   2. Atypical Angina: 2 criteria from above
      1. Age 30-39: 34% likelihood (intermediate) in men and 12% in women (low)
      2. Age 40-49: 51% likelihood (intermediate) in men and 22% in women (low)
      3. Age 50-59: 65% likelihood (intermediate) in men and 31% in women (intermediate)
      4. Age 60-69: 72% likelihood (intermediate) in men and 51% in women (intermediate)
   3. Non-Anginal Chest Pain: 1 criteria from above
      1. Age 30-39: 4% likelihood (low) in men and 2% in women (low)
      2. Age 40-49: 13% likelihood (intermediate) in men and 3% in women (low)
      3. Age 50-59: 20% likelihood (intermediate) in men and 7% in women (low)
      4. Age 60-69: 27% likelihood (intermediate) in men and 14% in women (intermediate)
   4. No criteria present
      1. Risk is low to very low for both men and women
4. Application
   1. Low risk patient: Avoid stress testing (higher risk of false positives)
   2. Intermediate risk patient: Stress Testing
      1. Exercise Stress Test is first-line for most men and women
      2. Stress Imaging test if abnormal baseline EKG, prior revascularization, or Diabetes Mellitus
      3. Pharmacologic Stress Test if unable to Exercise
   3. High risk patient: Consider coronary angiogram
5. References
   1. Diamond (1979) N Engl J Med 300(24):1350-8 [PubMed]