Identifying priority patients for coronary angiography

We conducted an open observational study with blinded endpoint evaluation t o validate the use of the Duke treadmill score in identifying patients like ly to require coronary intervention. We studied 101 consecutive patients re ferred for coronary angiography from a cardiology clinic. All patients had a Bruce protocol exercise test, A 70% stenosis was regarded as significant. Patients were referred for percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) surgery, if indicated, The Duke score was calculated as follows: exercise time (min) - (5 x ST segmen t deviation [mm]) - (4 x angina index [text]), Patients were classified int o low, medium and high risk. The patients at high risk are more likely to h ave a significant stenosis (53/58 vs 30/43, p=0.01 [OR 4.59 95% CI 1.34-16. 6]) and require CABG or PTCA (47/58 vs 16/43, p<0.001 [OR 7.21 95% CI 2.69- 19.8]) than those at medium/low risk. Multiple logistic regression analysis , including ST segment depression, exercise time and symptoms shows that th e score independently predicts a significant stenosis (p=0.002) and the nee d for coronary intervention (p=0.001), Introducing the score can help to id entify those patients who need priority investigation.