Duke Treadmill Score Calculator

The Duke Treadmill Score is a validated method for summarizing three findings from an exercise cardiac stress test: exercise duration, maximum exercise-induced ST-segment depression, and whether angina occurred. It was developed to help estimate prognosis and place patients into broad risk groups after treadmill testing. The score supports clinical interpretation but does not diagnose coronary artery disease by itself. The equation is exercise time in minutes minus five times maximum ST depression in millimeters minus four times the angina index. The angina index is zero when angina is absent, one when angina occurs but does not limit exercise, and two when angina stops or limits exercise. A patient exercising for 12.5 minutes with 0.5 mm depression and no angina has a score of 10. A patient exercising eight minutes with 2 mm depression and non-limiting angina has a score of minus 6. Traditional categories classify scores of 5 or higher as low risk, scores from minus 10 through 4 as moderate risk, and scores of minus 11 or lower as high risk. These groups were associated with different long-term cardiac outcomes in the populations used to derive and validate the score. Risk classification does not directly state one individual's probability, and management depends on pretest probability, symptoms, exercise capacity, hemodynamic response, rhythm, imaging, and other clinical factors. Exercise duration should come from the Bruce protocol. If another protocol was used, clinicians may convert workload or exercise capacity according to an accepted method rather than entering raw minutes as though the protocols were identical. ST depression must be measured and interpreted on a technically adequate ECG. Baseline abnormalities, medications, inability to reach an adequate workload, and certain conduction patterns can make an exercise ECG less suitable or less interpretable. Only trained professionals should order, supervise, and interpret stress testing because exercise can provoke serious symptoms or arrhythmias. This calculator is intended to reproduce score arithmetic from an already completed test, not to evaluate chest pain at home. Call emergency services for current chest pressure, severe shortness of breath, fainting, or other possible signs of an acute cardiac event. Discuss any moderate or high score with the clinician responsible for the test, who can determine whether observation, medical therapy, imaging, or angiographic evaluation is appropriate.