title: A prognostic scoring system for arm exercise stress testing.
abstract: Arm exercise stress testing may be an equivalent or better predictor of mortality outcome than pharmacological stress imaging for the ≥50% for patients unable to perform leg exercise. Thus, our objective was to develop an arm exercise ECG stress test scoring system, analogous to the Duke Treadmill Score, for predicting outcome in these individuals.
  
  
  
  In this retrospective observational cohort study, arm exercise ECG stress tests were performed in 443 consecutive veterans aged 64.1 (11.1) years. (mean (SD)) between 1997 and 2002. From multivariate Cox models, arm exercise scores were developed for prediction of 5-year and 12-year all-cause and cardiovascular mortality and 5-year cardiovascular mortality or myocardial infarction (MI).
  
  
  
  Arm exercise capacity in resting metabolic equivalents (METs), 1 min heart rate recovery (HRR) and ST segment depression ≥1 mm were the stress test variables independently associated with all-cause and cardiovascular mortality by step-wise Cox analysis (all p<0.01). A score based on the relation HRR (bpm)+7.3×METs-10.5×ST depression (0=no; 1=yes) prognosticated 5-year cardiovascular mortality with a C-statistic of 0.81 before and 0.88 after adjustment for significant demographic and clinical covariates. Arm exercise scores for the other outcome end points yielded C-statistic values of 0.77-0.79 before and 0.82-0.86 after adjustment for significant covariates versus 0.64-0.72 for best fit pharmacological myocardial perfusion imaging models in a cohort of 1730 veterans who were evaluated over the same time period.
  
  
  
  Arm exercise scores, analogous to the Duke Treadmill Score, have good power for prediction of mortality or MI in patients who cannot perform leg exercise.
authors.affiliation: Clinical Epidemiology Center of the St. Louis Veterans Administration Medical Center, College of Public Health and Social Justice, St. Louis University , St. Louis, Missouri , USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Clinical Epidemiology Center of the St. Louis Veterans Administration Medical Center, College of Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA; Department of Biostatistics, College of Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Xian
authors.affiliation: Department of Epidemiology , College of Public Health and Social Justice, St. Louis University , St. Louis, Missouri , USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Chandiramani
authors.affiliation: Department of Internal Medicine , Washington University School of Medicine , St. Louis, Missouri , USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Bainter
authors.affiliation: Department of Biostatistics , College of Public Health and Social Justice, St. Louis University , St. Louis, Missouri , USA.
authors.forename: Leping
authors.initials: L
authors.lastname: Wan
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Louis Veterans Administration Medical Center and Washington University School of Medicine , St. Louis, Missouri , USA.
authors.forename: Wade H
authors.initials: WH
authors.lastname: Martin
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