Raxwal et al developed a simple treadmill score for identifying men with coronary artery disease. The authors are from the Stanford University, the Veterans Administration Palo Alto Health Center and the University of West Virginia.
Patients: The score was developed in patients in 2 VA hospitals. The majority of patients studied were male.
Significant coronary artery disease was defined as a >= 50% occlusion of the left anterior descending, left circumflex, right main, left main coronary arteries or their major branches.
Parameters:
(1) maximal heart rate achieved during treadmill testing
(2) treadmill exercise-induced ST segment depression
(3) age of the patient
(4) angina history
(5) hypercholesterolemia
(6) diabetes mellitus
(7) treadmill exercise-induced angina
|
Parameter |
Findings |
Points |
|
maximal heart rate |
190 to 220 beats per minute |
1 |
|
|
160 to 189 beats per minute |
2 |
|
|
130 to 159 beats per minute |
3 |
|
|
100 to 129 beats per minute |
4 |
|
|
< 100 beats per minute |
5 |
|
exercise induced ST segment depression |
< 1 mm |
0 |
|
|
1 – 2 mm |
3 |
|
|
> 2 mm |
5 |
|
age of the patient |
< 40 |
0 |
|
|
40 – 55 |
3 |
|
|
> 55 |
5 |
|
angina history |
none |
0 |
|
|
noncardiac chest pain |
1 |
|
|
probable |
3 |
|
|
atypical |
3 |
|
|
definite/typical |
5 |
|
hypercholesterolemia |
no |
0 |
|
|
yes |
5 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
5 |
|
treadmill exercise induced angina |
none |
0 |
|
|
occurred but not reason for stopping test |
3 |
|
|
reason for stopping treadmill testing |
5 |
score =
= (6 * (points for maximal heart rate)) + (5 * (points for ST segment depression)) + (4 * (points for age)) + (points for angina history) + (points for hypercholesterolemia) + (points for diabetes mellitus) + (points for treadmill angina)
Interpretation:
• minimum score: 1
• maximum score: 95
• The higher the score the greater the probability of coronary artery disease.
|
Score |
Probability of Coronary Artery Disease |
|
< 40 |
low |
|
40 – 60 |
intermediate |
|
> 60 |
high |
Performance:
• Sensitivity 88% and specificity 96%.
Specialty: Cardiology, Sports Medicine & Rehabilitation
ICD-10: ,
