The Duke treadmill score (DTS) combines exercise duration, maximal ST-segment deviation and exercise-induced angina from a standard Bruce treadmill ECG to estimate prognosis in patients with suspected or known coronary artery disease.

The score was derived and validated by Mark et al. in outpatients with suspected coronary disease and has since been widely validated and incorporated into exercise testing guidance.

Risk group	DTS range	Approx annual cardiac mortality	Approx 4-5 year survival
Low	≥5	~0.25%	~97-99%
Intermediate	-10 to +4	~1-2%	~90-95%
High	≤ -11	~5%	~65-79%

Use DTS alongside clinical assessment and local chest pain pathways. It is not designed for haemodynamically unstable patients or for those unable to exercise adequately.

The score is only valid after an interpretable exercise ECG with adequate workload. Baseline ECG abnormalities, pharmacologic stress tests and inability to exercise require different pathways.

Duke Treadmill Score