Your Duke Treadmill Score places you into one of three prognostic categories. A score of 5 or higher indicates low risk, with an annual cardiac mortality rate below 1% and a 5-year survival of approximately 97%. These patients generally do not require further invasive testing. A score between -10 and +4 indicates moderate risk, with annual mortality of 2-3%. Additional workup such as stress echocardiography, nuclear perfusion imaging, or coronary CT angiography may be appropriate. A score below -10 indicates high risk, with annual mortality of 5% or greater, and coronary angiography is typically recommended.

The score integrates exercise capacity, ischemic burden (ST deviation), and symptom severity into a single prognostic index. A low score driven primarily by poor exercise capacity has different clinical implications than one driven by marked ST depression, so the individual components should also be considered in clinical decision-making.

Use the Duke Treadmill Score after a standard exercise treadmill test (Bruce protocol) to help stratify patients with suspected or known coronary artery disease. It is most useful for intermediate-risk patients being evaluated for stable chest pain or exertional symptoms where the pre-test probability of significant CAD is neither very low nor very high.

The score is particularly valuable in settings where stress imaging is not immediately available, as it helps determine which patients can be safely managed conservatively and which need further workup. It is also used in cardiology guidelines to guide the decision between medical therapy and invasive evaluation.

The Duke Treadmill Score was validated using the standard Bruce treadmill protocol. If a different exercise protocol was used, the exercise time component may not be directly comparable. The score also assumes that ST-segment changes are interpretable — it should not be applied to patients with baseline ST abnormalities from left bundle branch block, left ventricular hypertrophy with repolarization changes, digitalis use, or pre-excitation syndromes.

The DTS was derived and validated predominantly in male patients with suspected CAD. Its accuracy may be lower in women and in populations with low prevalence of obstructive CAD. It does not account for additional stress test findings such as exercise-induced arrhythmias, blood pressure response, or heart rate recovery, which also carry prognostic significance.