Value of Duke treadmill score in predicting coronary artery lesion and the need for revascularisation

Abstract

A b s t r a c tBackground: Exercise electrocardiography is a long-standing method for the evaluation of coronary artery disease (CAD), and it remains the initial test for most patients who can exercise adequately with a baseline interpretable electrocardiogram. However, there is little information about the relationship between Duke treadmill test score (DTS) and severity of coronary artery lesion, as well as estimating the need for revascularisation. Aim:The aim of the study was to ascertain whether the DTS could be an efficient parameter in choosing coronary revascularisation in different DTS groups. Methods:Two hundred and fifty-eight (n = 258) patients had positive exercise testing for CAD and underwent coronary angiography. The patients were divided into three groups according to the DTS: low-risk (with a score of ≥ +5), moderate-risk (with scores ranging from -10 to +4), and high-risk (with a score of ≤ -11). Coronary angiography was done by the Judkins technique. A coronary lesion was considered significant when stenosis of the coronary artery was ≥ 70% and stenosis of the trunk was ≥ 50%. The SYNTAX score was determined. Results:The study group included 258 patients with mean age 62.66 ± 9.6 years, and most of them were men (72.8%). Patients with high-and intermediate-risk DTS had the same SYNTAX score (16.35 ± 7.3, 15.09 ± 10.08 and 11.80 ± 9.88, respectively; p = 0.064) compared to low-risk DTS. A negative correlation between DTS and significant coronary artery stenosis (r = -0.181; p = 0.005), SYNTAX score (r = -0.173; p = 0.007), and cardiac revascularisations (r = -0.213; p = 0.001) were found. In multiple linear regressions to predict coronary revascularisation the SYNTAX score (B = 0.018; p = 0.0001), DTS (B = -0.014, p = 0.008) and previous myocardial infarction (B = -0.143; p = 0.047) were significant predictors. Conclusions:The DTS alone is a useful tool in suspecting a significant coronary artery stenosis, but it is not accurate enough for revascularisation. Thus, by adding clinical information, its value may be maximised.

Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

“…These patients may have had uncontrolled hypertension, where higher baseline systolic and diastolic blood pressure led to an exaggerated systolic and diastolic blood pressure response during EST, as demonstrated previously [20]. The DTS has been negatively correlated with the SYNTAX score [21,22], although the correlation coefficients varied greatly between different studies. For example, in 65 patients with a positive exercise test and who underwent coronary angiography, Acar et al [21] found a strong negative correlation between the DTS and SYNTAX score (r = -0.91, p < 0.001).…”

“…For example, in 65 patients with a positive exercise test and who underwent coronary angiography, Acar et al [21] found a strong negative correlation between the DTS and SYNTAX score (r = -0.91, p < 0.001). On the other hand, in a cohort of 258 patients with EST and coronary angiography, Dzenkeviciute et al [22] demonstrated a weak correlation (r = -0.173; p = 0.007) between the two scores. Günaydın et al [23] reported that the DTS was an independent predictor of a high SYNTAX score in 267 patients who underwent coronary angiography after a positive EST [23].…”

Maximising the Diagnostic Utility of the Exercise Treadmill Test

“…Patients with good scores are unlikely to have a significant benefit even if they have revascularization done [4]. This however does not eliminate the need for correlation with clinical history [13]. This patient's DTS of -15 made him a high-risk patient with a 1-year mortality of 8.3% without any intervention.…”

“…The Duke Treadmill Score (DTS) predicts the likelihood of ischaemia due to an obstructive lesion, based on exercise time, ST deviation and chest pain [4,13,14]. The duration of exercise at which symptoms and ST segment changes occur, which serves as a surrogate for the workload done i.e.…”

“…The use of the DTS improves the overall sensitivity of the ETT [4] and is therefore advised to avert performing unnecessary coronary angiograms. The DTS has a significant diagnostic and prognostic value in the assessment of CAD, as well as predicting need for revascularization [10,13,14]. Patients with good scores are unlikely to have a significant benefit even if they have revascularization done [4].…”