From the Center for Cardiovascular Epidemiology, Division of Cardiology,
Emory University, Atlanta, Ga.
Correspondence to Leslee J. Shaw, PhD, Center for Cardiovascular Epidemiology, Division of Cardiology, Room 638, 1518 Clifton Rd NE, Atlanta, GA 30322. E-mail lshaw{at}cces.emory.edu
Background—Exercise testing is
useful in the assessment of symptomatic patients for
diagnosis of significant or extensive coronary disease and to
predict their future risk of cardiac events. The Duke treadmill score
(DTS) is a composite index that was designed to provide survival
estimates based on results from the exercise test, including ST-segment
depression, chest pain, and exercise duration. However, its usefulness
for providing diagnostic estimates has yet to be
determined.
Methods and Results—A logistic regression model was used to
predict significant (
Conclusions—The composite DTS provides accurate
diagnostic and prognostic information for the evaluation of
symptomatic patients evaluated for clinically suspected
ischemic heart disease.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups
75% stenosis) and severe (3-vessel or
left main) coronary artery disease, and a Cox regression
analysis was used to predict cardiac survival. After adjustment
for baseline clinical risk, the DTS was effectively
diagnostic for significant (P<0.0001) and
severe (P<0.0001) coronary artery disease. For
low-risk patients (score +5), 60% had no coronary
stenosis 75% and 16% had single-vessel 75%
stenosis. By comparison, 74% of high-risk patients (score
<-11) had 3-vessel or left main coronary disease. Five-year
mortality was 3%, 10%, and 35% for low-, moderate-, and high-risk
DTS groups (P<0.0001).
Key Words: exercise • tests • prognosis • coronary artery disease
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