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

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.