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Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease.

Publication ,  Journal Article
Mark, DB; Shaw, L; Harrell, FE; Hlatky, MA; Lee, KL; Bengtson, JR; McCants, CB; Califf, RM; Pryor, DB
Published in: N Engl J Med
September 19, 1991

BACKGROUND: The treadmill exercise test identifies patients with different degrees of risk of death from cardiovascular events. We devised a prognostic score, based on the results of treadmill exercise testing, that accurately predicts outcome among inpatients referred for cardiac catheterization. This study was designed to determine whether this score could also accurately predict prognosis in unselected outpatients. METHODS: We prospectively studied 613 consecutive outpatients with suspected coronary disease who were referred for exercise testing between 1983 and 1985. Follow-up was 98 percent complete at four years. The treadmill score was calculated as follows: duration of exercise in minutes--(5 x the maximal ST-segment deviation during or after exercise, in millimeters)--(4 x the treadmill angina index). The numerical treadmill angina index was 0 for no angina, 1 for nonlimiting angina, and 2 for exercise-limiting angina. Treadmill scores ranged from -25 (indicating the highest risk) to +15 (indicating the lowest risk). RESULTS: Predicted outcomes for the outpatients, based on their treadmill scores, agreed closely with the observed outcomes. The score accurately separated patients who subsequently died from those who lived for four years (area under the receiver-operating-characteristic curve = 0.849). The treadmill score was a better discriminator than the clinical data and was even more useful for outpatients than it had been for inpatients. Approximately two thirds of the outpatients had treadmill scores indicating low risk (greater than or equal to +5), reflecting longer exercise times and little or no ST-segment deviation, and their four-year survival rate was 99 percent (average annual mortality rate, 0.25 percent). Four percent of the outpatients had scores indicating high risk (less than -10), reflecting shorter exercise times and more severe ST-segment deviation; their four-year survival rate was 79 percent (average annual mortality rate, 5 percent). CONCLUSIONS: The treadmill score is a useful and valid tool that can help clinicians determine prognosis and decide whether to refer outpatients with suspected coronary disease for cardiac catheterization. In this study, it was a better predictor of outcome than the clinical assessment.

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Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

September 19, 1991

Volume

325

Issue

12

Start / End Page

849 / 853

Location

United States

Related Subject Headings

  • Time Factors
  • Prospective Studies
  • Prognosis
  • Outpatients
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female
  • Exercise Test
 

Citation

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Mark, D. B., Shaw, L., Harrell, F. E., Hlatky, M. A., Lee, K. L., Bengtson, J. R., … Pryor, D. B. (1991). Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med, 325(12), 849–853. https://doi.org/10.1056/NEJM199109193251204
Mark, D. B., L. Shaw, F. E. Harrell, M. A. Hlatky, K. L. Lee, J. R. Bengtson, C. B. McCants, R. M. Califf, and D. B. Pryor. “Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease.N Engl J Med 325, no. 12 (September 19, 1991): 849–53. https://doi.org/10.1056/NEJM199109193251204.
Mark DB, Shaw L, Harrell FE, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991 Sep 19;325(12):849–53.
Mark, D. B., et al. “Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease.N Engl J Med, vol. 325, no. 12, Sept. 1991, pp. 849–53. Pubmed, doi:10.1056/NEJM199109193251204.
Mark DB, Shaw L, Harrell FE, Hlatky MA, Lee KL, Bengtson JR, McCants CB, Califf RM, Pryor DB. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991 Sep 19;325(12):849–853.
Journal cover image

Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

September 19, 1991

Volume

325

Issue

12

Start / End Page

849 / 853

Location

United States

Related Subject Headings

  • Time Factors
  • Prospective Studies
  • Prognosis
  • Outpatients
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female
  • Exercise Test