Risk stratification of patients in an emergency department chest pain unit: prognostic value of exercise treadmill testing using the Duke score

Abstract

BackgroundExercise treadmill testing (ETT) has been standard for evaluating outpatients at risk for cardiovascular events. Few studies have demonstrated its prognostic usefulness in emergency department chest pain units or have used the Duke score [(exercise duration in minutes) − (5 × ST-segment deviation in millimeters) − (4 × treadmill angina index)] to grade its performance.Aims Our objective was to assess the usefulness of this score in a chest pain unit to predict cardiovascular events.MethodsFrom November 2000 to October 2001, we retrospectively studied consecutive patients in the chest pain unit. Those undergoing ETT were stratified into “low” (Duke score ≥ 5) and “moderate/high” risk groups (< 5). Cardiovascular events defined as death, myocardial infarction > 24 h after presentation, revascularization, acute congestive heart failure, stroke or arrhythmia were identified within 1 year after presentation. Differences in risk of having a cardiovascular event among low-risk and moderate/high-risk groups are presented.ResultsDuring the study period, 1,048 patients entered the chest pain unit; 800 met inclusion criteria. Of these, 599 received ETT and 201 had contraindications or a positive finding in the chest pain unit protocol before ETT. Cardiovascular event rates were 0.7% (3/454), 15.2% (22/145) and 14.9% (30/201) after 1 month of follow-up for low-risk, moderate/high-risk and no-ETT groups, respectively.ConclusionsAccording to the Duke score, the low-risk group developed minimal cardiovascular events compared with the moderate/high-risk group. The Duke score appears effective for risk stratification of chest pain patients in chest pain units.

Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes

“…Conversely, exercise treadmill testing still has prognostic value when used in the right patient population (low pre-test probability as opposed to intermediate or high pre-test probability). The Duke treadmill score can be used for the detection of patients who are at high risk of a future cardiac event [ 48 ]. Table 8 shows other indicators of poor prognosis in severe CAD by exercise treadmill testing [ 49 – 51 ] (see Table 9 ).…”

Chest Pain Evaluation: Diagnostic Testing

“… 57 Thus, although the accuracy of EST has been surpassed by techniques combining stress with imaging or by anatomic testing, EST continues to be relied upon for prognosis and can help decision making with regard to the urgency of further investigations. 58 , 59 …”