title: Value of Duke treadmill score in predicting coronary artery lesion and the need for revascularisation.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Clinic of Internal Medicine, Oncology, and Family Medicine, Vilnius University Medical Faculty, Vilnius, Lithuania. vilma.dzenkeviciute@santa.lt.
authors.forename: Vilma
authors.initials: V
authors.lastname: Dzenkeviciute
authors.forename: Virginijus
authors.initials: V
authors.lastname: Sapoka
authors.forename: Vytautas
authors.initials: V
authors.lastname: Kasiulevicius
authors.forename: Egidija
authors.initials: E
authors.lastname: Rinkuniene
authors.forename: Rima
authors.initials: R
authors.lastname: Steponeniene
authors.forename: Rūta
authors.initials: R
authors.lastname: Einikyte
authors.forename: Austėja
authors.initials: A
authors.lastname: Dapkeviciute
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000601:surgery; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: Duke treadmill score; SYNTAX score; exercise stress test; previous cardiovascular outcomes; revascularisation