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本文引用的文献

1
Validation of a modified scoring system for cardiovascular risk associated with major lung resection.改良的主要肺切除相关心血管风险评分系统的验证。
Eur J Cardiothorac Surg. 2012 Mar;41(3):598-602. doi: 10.1093/ejcts/ezr081. Epub 2011 Dec 1.
2
The Society of Thoracic Surgeons practice guideline on the prophylaxis and management of atrial fibrillation associated with general thoracic surgery: executive summary.胸外科医师协会关于普通胸外科手术相关心房颤动的预防和管理的实践指南：执行摘要
Ann Thorac Surg. 2011 Sep;92(3):1144-52. doi: 10.1016/j.athoracsur.2011.06.104.
3
External validation of the recalibrated thoracic revised cardiac risk index for predicting the risk of major cardiac complications after lung resection.校正后的胸外科修订心脏风险指数在预测肺切除术后主要心脏并发症风险中的外部验证。
Ann Thorac Surg. 2011 Aug;92(2):445-8. doi: 10.1016/j.athoracsur.2011.03.095. Epub 2011 Jun 24.
4
2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.2011年美国心脏病学会基金会/美国心脏协会/心律学会重点更新内容纳入《2006年美国心脏病学会/美国心脏协会/欧洲心脏病学会心房颤动患者管理指南》：美国心脏病学会基金会/美国心脏协会实践指南工作组报告
Circulation. 2011 Mar 15;123(10):e269-367. doi: 10.1161/CIR.0b013e318214876d. Epub 2011 Mar 7.
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Guidelines on the radical management of patients with lung cancer.肺癌患者的根治性治疗指南。
Thorax. 2010 Oct;65 Suppl 3:iii1-27. doi: 10.1136/thx.2010.145938.
6
Recalibration of the revised cardiac risk index in lung resection candidates.肺切除候选者中修订后的心脏风险指数的再校准。
Ann Thorac Surg. 2010 Jul;90(1):199-203. doi: 10.1016/j.athoracsur.2010.03.042.
7
The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients.新英格兰心血管风险指数（VSG-CRI）血管外科患者的血管研究小组预测心脏并发症比修订后的心血管风险指数更准确。
J Vasc Surg. 2010 Sep;52(3):674-83, 683.e1-683.e3. doi: 10.1016/j.jvs.2010.03.031. Epub 2010 Jun 8.
8
Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.系统评价：修订后的心脏风险指数对围手术期心脏并发症和死亡率的预测。
Ann Intern Med. 2010 Jan 5;152(1):26-35. doi: 10.7326/0003-4819-152-1-201001050-00007.
9
Prediction of major adverse cardiac events in vascular surgery: are cardiac risk scores of any practical value?血管外科手术中主要不良心脏事件的预测：心脏风险评分有实际价值吗？
Vasc Endovascular Surg. 2010 Jan;44(1):14-9. doi: 10.1177/1538574409349320. Epub 2009 Oct 14.
10
ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy).欧洲呼吸学会/欧洲胸外科协会关于肺癌患者（手术及放化疗）接受根治性治疗适宜性的临床指南。
Eur Respir J. 2009 Jul;34(1):17-41. doi: 10.1183/09031936.00184308.

修订后的心脏风险指数能否预测择期肺切除术后的心脏并发症？

Does the revised cardiac risk index predict cardiac complications following elective lung resection?

作者信息

Wotton Robin, Marshall Andrea, Kerr Amy, Bishay Ehab, Kalkat Maninder, Rajesh Pala, Steyn Richard, Naidu Babu, Abdelaziz Mahmoud, Hussain Khalid

机构信息

Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.

出版信息

J Cardiothorac Surg. 2013 Dec 1;8:220. doi: 10.1186/1749-8090-8-220.

DOI:10.1186/1749-8090-8-220
PMID:24289748
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3879030/
Abstract

BACKGROUND

Revised Cardiac Risk Index (RCRI) score and Thoracic Revised Cardiac Risk Index (ThRCRI) score were developed to predict the risks of postoperative major cardiac complications in generic surgical population and thoracic surgery respectively. This study aims to determine the accuracy of these scores in predicting the risk of developing cardiac complications including atrial arrhythmias after lung resection surgery in adults.

METHODS

We studied 703 patients undergoing lung resection surgery in a tertiary thoracic surgery centre. Observed outcome measures of postoperative cardiac morbidity and mortality were compared against those predicted by risk.

RESULTS

Postoperative major cardiac complications and supraventricular arrhythmias occurred in 4.8% of patients. Both index scores had poor discriminative ability for predicting postoperative cardiac complications with an area under receiver operating characteristic (ROC) curve of 0.59 (95% CI 0.51-0.67) for the RCRI score and 0.57 (95% CI 0.49-0.66) for the ThRCRI score.

CONCLUSIONS

In our cohort, RCRI and ThRCRI scores failed to accurately predict the risk of cardiac complications in patients undergoing elective resection of lung cancer. The British Thoracic Society (BTS) recommendation to seek a cardiology referral for all asymptomatic pre-operative lung resection patients with > 3 RCRI risk factors is thus unlikely to be of clinical benefit.

摘要

背景

修订心脏风险指数（RCRI）评分和胸科修订心脏风险指数（ThRCRI）评分分别用于预测普通外科人群和胸科手术术后主要心脏并发症的风险。本研究旨在确定这些评分在预测成人肺切除术后发生包括房性心律失常在内的心脏并发症风险方面的准确性。

方法

我们研究了一家三级胸科手术中心的703例接受肺切除手术的患者。将术后心脏发病率和死亡率的观察结果与风险预测结果进行比较。

结果

4.8%的患者发生了术后主要心脏并发症和室上性心律失常。两种指数评分在预测术后心脏并发症方面的判别能力较差，RCRI评分的受试者工作特征（ROC）曲线下面积为0.59（95%CI 0.51 - 0.67），ThRCRI评分为0.57（95%CI 0.49 - 0.66）。

结论

在我们的队列中，RCRI和ThRCRI评分未能准确预测择期肺癌切除患者的心脏并发症风险。因此，英国胸科学会（BTS）建议对所有术前无症状且RCRI风险因素>3的肺切除患者进行心脏病转诊，这可能不会带来临床益处。