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Key Publications February 11, 2008

An externally validated model for predicting long-term survival after exercise treadmill testing in patients with suspected coronary artery disease and a normal electrocardiogram.

Ann Intern Med 2007;147:821-8

Lauer MS, Pothier CE, Magid DJ, Smith SS, Kattan MW

Description

In this article, the authors compare an externally validated model with the current Duke treadmill score standard for predicting all-cause mortality in patients with suspected coronary artery disease and a normal electrocardiogram. The proposed nomogram-illustrated model incorporates clinical variables (including age, sex, smoking, and diabetes) as well as treadmill variables that can easily be obtained in a stress laboratory (including exercise capacity, heart rate recovery, and ventricular ectopy during recovery) and do not require blood testing. A total of 33,268 patients were included in the study and followed for a median of 6.2 years. The nomogram outperformed the Duke treadmill score in both discrimination and calibration. For example, the model’s better performance enabled 64% of patients identified as intermediate and high risk by the Duke treadmill to be reclassified as low risk. The new model was also found to be superior for predicting all-cause mortality. Lastly, because variables included in the nomogram are all easily obtained, the authors recommended including them in the standard clinical risk report.
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