A prognostic scoring system for arm exercise stress testing.

Area of Science:

• Cardiology
• Exercise Physiology
• Predictive Analytics

Background:

• Patients unable to perform leg exercise often require alternative stress testing methods.
• Arm exercise electrocardiogram (ECG) stress testing is a viable option for this population.
• Predictive scoring systems are crucial for risk stratification and patient management.

Purpose of the Study:

• To develop an arm exercise ECG stress test scoring system.
• To create a tool analogous to the Duke Treadmill Score for outcome prediction.
• To evaluate the predictive accuracy of this new score for mortality and myocardial infarction.

Main Methods:

• Retrospective observational cohort study of 443 veterans undergoing arm exercise ECG stress tests.
• Development of multivariate Cox models to identify independent predictors of mortality.
• Creation of an arm exercise score using heart rate recovery (HRR), metabolic equivalents (METs), and ST segment depression.

Main Results:

• Arm exercise capacity (METs), 1-minute HRR, and ST segment depression were independently associated with mortality.
• The developed arm exercise score prognosticated 5-year cardiovascular mortality with a C-statistic of 0.81 (0.88 adjusted).
• The score demonstrated superior or equivalent predictive performance compared to pharmacological stress imaging models.

Conclusions:

• Arm exercise scores effectively predict mortality and myocardial infarction in patients unable to perform leg exercise.
• This scoring system offers a valuable tool for risk assessment in this specific patient group.
• The findings support the utility of arm exercise ECG stress testing for outcome prediction.