Comparative Evaluation of Treadmill-Based Risk Scores: Insights into Coronary Risk Stratification and Clinical Utility

Introduction:Treadmill stress electrocardiogram (ECG) testing is widely used for coronary artery disease (CAD) assessment, but its accuracy is limited when based solely on ST-segment changes and exercise capacity.Several treadmill-based risk scores-Duke Treadmill score (DTS), Morise score (MS), Cleveland clinic prognostic score (CCPS), FIT Treadmill score (FITTS), and Rancho Bernardo score (RBS)aim to improve risk stratification, but their comparative effectiveness remains unclear.This study evaluates their correlation and clinical applicability.Methods: This cross-sectional study analyzed 136 patients undergoing treadmill stress testing at a cardiology outpatient clinic.Patients with contraindications or significant baseline ECG abnormalities were excluded.Demographic, clinical, and exercise test parameters were recorded.Risk scores were calculated using predefined equations, and Spearman's rank correlation was used to assess relationships among scores.Results: The cohort had a mean age of 4613 years, with 43.4% women.Cardiovascular risk factors were common, including hyperlipidemia (24.3%), diabetes (11.8%), hypertension (25%), and smoking (43.4%).The categorical agreement was moderate between DTS and MS (=0.42) between CCPS and MS (=0.37),fair between MS and FITTS, DTS and RBS, and FITTS and CCPS (=0.23-0.32),and only slight for the remaining pairs (=0.07-0.12).Risk categorization varied significantly, with DTS and MS, predominantly classifying patients as low-risk, while FITTS and RBS provided a broader risk distribution. Conclusion:Treadmill risk scores vary in the context of CAD risk classification.DTS is useful for identifying high-risk patients, while FITTS and CCPS may better assess lower-risk individuals.Combining scores may enhance risk stratification.Further research with long-term outcomes is needed.