Predictive value of atrial pacing test for survival of patients with coronary artery disease.

There is evidence that patients with signs of poor left ventricular function or marked ischemia at low work load during an exercise test have a poor prognosis for survival. To determine whether a pacing test can provide similar information, the 6-yr survival rate was computed in 118 medically-treated patients who had undergone a standardized atrial pacing test. Among the 118 patients, 80 had significant coronary artery disease (CAD). The variables measured for the atrial pacing test were: induced angina, myocardial lactate extraction (MLE), maximal heart rate (MHR) and left ventricular end-diastolic pressure (LVEDP) changes. There was no death in 38 patients without significant CAD. The 6-yr survival rate of the 80 patients with CAD was 84 +/- 4% (+/- SEM). Of all the variables, the combinations of MHR less than or equal to 150 beats min-1 during pacing associated with a LVEDP increase greater than or equal to 5 mmHg immediately after pacing or with MLE less than or equal to 0% during pacing constituted the best predictors. Patients with a MHR less than or equal to 150 beats min-1 and a LVEDP increase greater than or equal to 5 mmHg had a 6-yr survival of 56 +/- 12% in comparison to 92 +/- 3% for the remaining patients (P less than 0.001). Patients with a MHR less than or equal to 150 beats min-1 and MLE less than or equal to 0% during pacing had a 6-yr survival of 64 +/- 11% in comparison to 91 +/- 4% for the remaining patients (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)