Duke Treadmill Score Calculator
Calculate the historical Duke Treadmill Score from standard Bruce equivalent exercise time, maximal ST-segment deviation, and the treadmill angina index.
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About
The Duke Treadmill Score combines standard Bruce protocol equivalent exercise duration, maximal qualifying ST-segment deviation, and an exercise-angina index. It was developed as a prognostic score in patients evaluated for suspected coronary artery disease and later tested in an outpatient cohort. It is not a stand-alone diagnosis of coronary disease. [1, 2]
This calculator requires a completed, clinically interpreted exercise ECG record. It does not decide whether exercise testing is appropriate, measure the ECG, convert another treadmill protocol to Bruce-equivalent time, or select imaging, angiography, medicines, or treatment.
Interpretation
Historical Duke Treadmill Score groups
High historical group
DTS < -10
Historical four-year survival: 79%
Intermediate historical group
-10 ≤ DTS < 5
Historical four-year survival: 95%
Low historical group
DTS ≥ 5
Historical four-year survival: 99%
The 99%, 95%, and 79% figures are historical four-year survival observations associated with low, intermediate, and high DTS groups; they are not a personalized survival probability. Group comparison uses the unrounded raw score. [2]
Current testing context
Current chest-pain and chronic-coronary-syndrome guidance chooses testing according to symptoms, pretest likelihood, exercise capacity, ECG interpretability, and available imaging. Exercise ECG can retain prognostic information, but it has lower diagnostic performance than contemporary anatomic and functional imaging in many settings. A DTS group alone does not authorize angiography or treatment. [6, 7]
Population and model limits
- Interpretation depends on the population, referral setting, protocol equivalence, ECG quality, and the complete exercise-test report.
- Women were underrepresented in early treadmill-score cohorts; later work evaluated performance in women and other diagnostic subgroups. [3, 4]
- The original DTS contains no age term. A 2008 age-adjusted nomogram was developed in 1,759 male veterans and required external validation and extension to women; it is a separate model and is not calculated here. [5]
References
- Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987;106(6):793–800. PMID 3579066. DOI 10.7326/0003-4819-106-6-793.
- Mark DB, Shaw L, Harrell FE Jr, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325(12):849–853. PMID 1875969. DOI 10.1056/NEJM199109193251204.
- Alexander KP, Shaw LJ, Shaw LK, Delong ER, Mark DB, Peterson ED. Value of exercise treadmill testing in women. J Am Coll Cardiol. 1998;32(6):1657–1664. PMID 9822093. DOI 10.1016/S0735-1097(98)00451-3.
- Shaw LJ, Peterson ED, Shaw LK, et al. Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. Circulation. 1998;98(16):1622–1630. PMID 9778327. DOI 10.1161/01.CIR.98.16.1622.
- Lai S, Kaykha A, Yamazaki T, et al. Age-adjusted modification of the Duke Treadmill Score nomogram. Am Heart J. 2008;155(6):1033–1038. PMID 18513516. DOI 10.1016/j.ahj.2008.01.025.
- Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. 2021;144(22):e368–e454. DOI 10.1161/CIR.0000000000001029.
- Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415–3537. DOI 10.1093/eurheartj/ehae177.
FAQ
Use the maximal qualifying net ST-segment deviation in millimeters during or after exercise from the interpreted ECG report, excluding lead aVR. This page does not measure or interpret an ECG tracing.
Sources: [2]
The historical outpatient groups are low at DTS ≥5, intermediate at −10 to below 5, and high below −10. QuickMedCalc compares the exact unrounded score with those boundaries; a group is not a diagnosis or an automatic care pathway.
Sources: [2]
No. They are historical four-year survival observations reported for the low-, intermediate-, and high-score groups in the 1991 outpatient cohort. They are not a personalized probability and should not be transferred automatically to a different population or current care setting.
Sources: [2]
No. The score is one part of an interpreted exercise-test record. Current diagnostic and management choices depend on symptoms, clinical likelihood, exercise capacity, ECG interpretability, other findings, available imaging, and clinical judgment. This calculator does not order angiography or select treatment.
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Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.