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Related Experiment Video

Updated: Feb 4, 2026

Establishing a Competing Risk Regression Nomogram Model for Survival Data
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The ACE Equation Gives Equivalent Mortality Risk Estimates to the Duke Treadmill Score and Duke Nomogram.

Alexander H K Montoye1, Morgan R Fonley, Bradford S Westgate

  • 1Author Affiliations: Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan; Exercise Science Program, Montcalm Community College, Sidney, Michigan; (Dr Montoye); Department of Mathematics and Computer Science, Alma College, Alma, Michigan (Drs Fonley and Westgate); Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden (Dr Brudin); Department of Pulmonary Medicine, Allergology, and Palliative Medicine, Clinical Sciences, Lund University, Lund, Sweden (Dr Lindow); and Clinical Physiology, Department of Research and Development, Region Kronoberg, Vaxjo, Sweden (Dr Lindow).

Journal of Cardiopulmonary Rehabilitation and Prevention
|February 2, 2026
PubMed
Summary

A new Alma College Estimation (ACE) equation accurately estimates patient survival, matching the Duke nomogram and Duke treadmill score (DTS). This tool enhances prognostic accuracy for exercise test findings.

Keywords:
Bruce treadmill testcoronary artery diseasediagnosismortalitytreadmill test

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Area of Science:

  • Cardiology
  • Exercise Physiology
  • Biostatistics

Background:

  • Prognostic assessment of cardiovascular disease risk is crucial for patient management.
  • The Duke treadmill score (DTS) and Duke nomogram are established tools for estimating survival post-exercise testing.
  • There is a need for precise and user-friendly methods to interpret exercise test results.

Purpose of the Study:

  • To develop the Alma College Estimation (ACE) equation for survival estimation.
  • To create an equation equivalent to the Duke treadmill score (DTS) and Duke nomogram.
  • To provide a precise and easily applicable tool for clinical prognosis.

Main Methods:

  • Developed the ACE equation using combinations of ST segment deviation, angina symptoms, and metabolic equivalents.
  • Validated the equation against a clinical cohort of 10,673 patients from a Swedish hospital.
  • Compared ACE equation survival estimates with the Duke nomogram and DTS using mean absolute error and percent agreement.

Main Results:

  • The ACE equation is a non-linear, exponential function.
  • ACE equation 5-year survival estimates demonstrated significant equivalence (within 1%) to the Duke nomogram.
  • Low mean absolute error (0.7% ± 0.7%) and high percent agreement (83%-94%) in risk categorization were observed.

Conclusions:

  • The ACE equation provides survival estimates comparable to the Duke nomogram and DTS.
  • The ACE equation offers improved precision over the DTS and enhanced ease of use compared to the Duke nomogram.
  • This equation represents a valuable clinical tool for prognosis assessment based on exercise test results.