For healthcare professionals
Duke Treadmill Score
The Duke treadmill score combines three results of a treadmill exercise test (exercise time, ST-segment deviation and angina during exercise) into one number that estimates prognosis in suspected coronary artery disease. Mark and colleagues at Duke University published it in 1987 and 1991. This calculator is written for clinicians and is not a diagnosis.
Exercise test results
From a treadmill test using the Bruce protocol. Nothing you enter leaves this page.
What you will see
The score, the working, and the low, moderate or high risk band.
Educational only, not medical advice. Not a diagnosis. Further testing decisions belong to the treating team.
Source
Mark DB and colleagues, Annals of Internal Medicine 1987 and New England Journal of Medicine 1991. The formula is taken from an open-access (CC BY) study, Cuba Rodriguez AL and colleagues, 2025; the angina index, the ST rule and the risk bands from an open-access (CC BY 2.0) study, Greulich S and colleagues, Journal of Cardiovascular Magnetic Resonance 2012; the 4-year survival figures from an open-access (CC BY) review, Crispino SP and colleagues, Journal of Cardiovascular Development and Disease 2024. The tests check the formula, the ST rule, the band edges and the typical range.
Validated in
Outpatients with suspected coronary artery disease having a treadmill exercise test (Mark 1991). It is used to estimate prognosis and to help decide on referral for coronary angiography (Crispino 2024).
Limits
Band edges differ between sources: Greulich 2012 uses 5 or more, 4 to -10 and -11 or less; Cuba Rodriguez 2025 uses over 5, -11 to 4 and under -11; Crispino 2024 uses over 5 and under -10. This page follows Greulich 2012, and puts values between the whole-number edges (for example 4.5) in moderate. In 68 women, with the score calculated from a cycle ergometer test, it was similar in those with and without coronary artery disease (Greulich 2012). At least half of patients referred for exercise testing cannot exercise adequately on a treadmill (Crispino 2024). The typical range is -25 to +15 (Greulich 2012).
Formula
Duke treadmill score = exercise time in minutes - (5 x ST-segment deviation in mm) - (4 x angina index) (Cuba Rodriguez 2025).
Use the largest net ST deviation, elevation or depression, in any lead except aVR; a deviation under 1 mm is entered as 0. The angina index is 0 for no angina, 1 for nonlimiting angina and 2 for exercise-limiting angina (Greulich 2012).
| Risk | Score | Published survival |
|---|---|---|
| Low | 5 or more | 99% predicted 4-year survival (score above 5) |
| Moderate | 4 to -10 | - |
| High | -11 or less | 79% predicted 4-year survival (score below -10) |
Bands as used by Greulich and colleagues (Greulich 2012); survival figures as given by Crispino and colleagues (Crispino 2024). The score was developed by Mark and colleagues (Mark 1987) (Mark 1991).
Worked example: 9 minutes of exercise, 2 mm of ST depression and nonlimiting angina give 9 - 10 - 4 = -5, in the moderate band.
What the studies found
A score above 5 indicates low risk, and these patients do not need further investigation with coronary angiography; a score below -10 indicates high risk, and these patients need coronary angiography (Crispino 2024). Cardiopulmonary exercise testing measures such as peak oxygen uptake give more detailed prognostic information than the score (Crispino 2024).
In a study of 68 women, exercise ECG had a sensitivity of 50% and a specificity of 73% for coronary artery disease, against 85% and 94% for stress perfusion cardiac MRI (Greulich 2012).
Related calculators
For chest pain in the emergency department, see the HEART score calculator. For 10-year heart disease and stroke risk, see the ASCVD risk calculator. Other bedside scores are listed under For healthcare professionals.
Sources
- Cuba Rodriguez AL, Aldama Perez LI, Hernandez Navas M, Goelkel Perez SJ. Follow-up of patients with myocardial ischemia without obstructive coronary lesions. Arch Peru Cardiol Cir Cardiovasc. 2025;6(2):69-74. doi:10.47487/apcyccv.v6i2.472. PMID 40718070. Open access (CC BY). Methods (Duke treadmill score formula, range and bands). pmc.ncbi.nlm.nih.gov/articles/PMC12288738/
- Greulich S, Bruder O, Parker M, et al. Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women. J Cardiovasc Magn Reson. 2012;14:36. doi:10.1186/1532-429X-14-36. PMID 22697372. Open access (CC BY 2.0). Methods (ST rule, angina index, typical range, low, moderate and high risk bands) and Results. pmc.ncbi.nlm.nih.gov/articles/PMC3411505/
- Crispino SP, Segreti A, Ciancio M, et al. The Complementary Role of Cardiopulmonary Exercise Testing in Coronary Artery Disease: From Early Diagnosis to Tailored Management. J Cardiovasc Dev Dis. 2024;11(11):357. doi:10.3390/jcdd11110357. PMID 39590200. Open access (CC BY). Section on exercise testing (Duke treadmill score over 5, 99% and under -10, 79% predicted 4-year survival). pmc.ncbi.nlm.nih.gov/articles/PMC11594985/
- Mark DB, Hlatky MA, Harrell FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987;106(6):793-800. doi:10.7326/0003-4819-106-6-793. PMID 3579066. pubmed.ncbi.nlm.nih.gov/3579066/
- Mark DB, Shaw L, Harrell FE, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325(12):849-853. doi:10.1056/NEJM199109193251204. PMID 1875969. pubmed.ncbi.nlm.nih.gov/1875969/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-02. Spotted an error? See About.