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Duke Treadmill Score

Duke Treadmill Score = exercise time (min, Bruce) − 5 × maximal ST deviation (mm) − 4 × angina index. ≥+5 is low risk (~99% 4-year survival), −10 to +4 moderate (~95%), ≤−11 high (~79%).

  • Exercise time (Bruce protocol) (min)
  • Maximal ST deviation (any lead, excluding aVR) (mm)
  • Angina during test: None (0); Non-limiting angina (1); Exercise-limiting angina (2)
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Interpretation

ResultMeaning
≥ +5Low risk
−10 to +4Moderate risk
≤ −11High risk

Formula

DTS = exercise time (min) − (5 × ST deviation in mm) − (4 × angina index); angina index 0 none, 1 non-limiting, 2 exercise-limiting

Clinical pearls

  • Validated for the standard Bruce protocol only; not interpretable with baseline ECG abnormalities (LBBB, LVH with strain, digoxin, pre-excitation, paced rhythm).
  • Performs less well in patients over 75.

Examples

duke treadmill score 9 minutes, 1 mm st depression, non-limiting anginadts exercise time 12 min no st changes no anginatreadmill score 5 min 2.5 mm st, test stopped for chest pain

FAQ

What is a good Duke Treadmill Score?

+5 or higher is low risk, with about 99% four-year survival in outpatients with suspected CAD.

What ST deviation is used?

The largest net ST deviation in any lead other than aVR, measured in millimetres.

Evidence

  1. Mark DB et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991;325:849–53.
  2. Mark DB et al. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med 1987;106:793–800.

Cardiology · Reviewed 2026-10-14 · Methodology