Department of Surgery, The University of Chicago, Chicago, IL 60637, USA.
Eur J Cardiothorac Surg. 2012 Mar;41(3):598-602. doi: 10.1093/ejcts/ezr081. Epub 2011 Dec 1.
The well-known revised cardiac risk index (RCRI) has recently been modified based on factors and outcomes specific to thoracic surgery patients (ThRCRI). We explored the accuracy of this modified scoring system in predicting cardiovascular morbidity after major lung resection.
We analyzed outcomes from a prospective database of patients undergoing major lung resection 1980-2009. ThRCRI score was based on weighted factors for serum creatinine, coronary artery disease, cerebrovascular disease and extent of lung resection. Target adverse outcomes included pulmonary embolism, myocardial infarction, cardiac arrest, pulmonary edema and cardiac death.
A total of 1255 patients (mean age 61.8 years; 649 men) underwent lobectomy or bilobectomy (1070; 85%) or pneumonectomy (185; 15%) for cancer (1037; 83%) or other problems. Severe cardiovascular complications occurred in 30 patients (2.4%), an incidence similar to that in the published derivation group (3.3%). ThRCRI median scores in patients without and with severe CV complications were 0 and 1.5 (P < 0.001). Score categories yielded incremental risks of cardiovascular complications (0: 0.9%; 1-1.5: 4.5%; ≥ 2: 12.8%; P < 0.001). The Hosmer-Lemeshow test demonstrated no significant difference between expected and observed outcomes (P = 0.11).
The incidences of severe postoperative cardiovascular complications were similar in the published derivation group and the current validation group. The ThRCRI score successfully stratified risk for postoperative cardiovascular events after major lung resection in the validation group. The expected risk in the validation group was similar to the observed risk, indicating that ThRCRI accurately predicted specific risk rather than just relative risk. Further evaluation of the utility of this scoring system is warranted.
最近，基于特定于胸外科患者的因素和结果，对著名的修订后的心脏风险指数（RCRI）进行了修改（ThRCRI）。我们探讨了该改良评分系统在预测大肺切除术后心血管发病率方面的准确性。
我们分析了 1980 年至 2009 年接受大肺切除术的前瞻性数据库的结果。ThRCRI 评分基于血清肌酐、冠状动脉疾病、脑血管疾病和肺切除范围的加权因素。目标不良结局包括肺栓塞、心肌梗死、心脏骤停、肺水肿和心脏死亡。
共有 1255 例患者（平均年龄 61.8 岁；649 例男性）接受了肺叶切除术或双肺叶切除术（1070 例；85%）或全肺切除术（185 例；15%），用于癌症（1037 例；83%）或其他问题。30 例（2.4%）患者发生严重心血管并发症，发生率与发表的推导组相似（3.3%）。无严重 CV 并发症和有严重 CV 并发症患者的 ThRCRI 中位数分别为 0 和 1.5（P < 0.001）。评分类别显示心血管并发症的风险逐渐增加（0：0.9%；1-1.5：4.5%；≥2：12.8%；P < 0.001）。Hosmer-Lemeshow 检验表明预期结果与观察结果无显著差异（P = 0.11）。
在发表的推导组和当前的验证组中，严重术后心血管并发症的发生率相似。ThRCRI 评分成功地对验证组大肺切除术后心血管事件的风险进行了分层。验证组的预期风险与观察到的风险相似，表明 ThRCRI 准确预测了特定风险，而不仅仅是相对风险。进一步评估该评分系统的实用性是必要的。
