Thomas Daniel C, Blasberg Justin D, Arnold Brian N, Rosen Joshua E, Salazar Michelle C, Detterbeck Frank C, Boffa Daniel J, Kim Anthony W
Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Ann Thorac Surg. 2017 Aug;104(2):389-394. doi: 10.1016/j.athoracsur.2017.02.006. Epub 2017 May 9.
The Thoracic Revised Cardiac Index (ThRCRI) is a tool that differentiates patients who may proceed to lung resection (classes A or B) from those who should receive additional cardiac evaluation (classes C or D). This study aims to describe the ability of the ThRCRI to stratify patients based on major cardiac complication rates using a large multi-institutional dataset.
Patients undergoing lobectomy or pneumonectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2012. Patients were grouped into 4 risk classes based on a summary score of preoperative risk factors: ischemic heart disease, cerebrovascular disease, renal comorbidity, and pneumonectomy. The primary outcome was the incidence of perioperative major cardiac complication in each of the 4 risk classes.
Of the 4,625 patients identified, the majority underwent surgery for malignant disease (78%) and had an open procedure (70%). Among ThRCRI risk factors, 9% of patients had ischemic heart disease, 7% had cerebrovascular disease, 2% had renal comorbidity, and 6% underwent pneumonectomy. Incidence of cardiac complication in all patients was 2%. Incidence of cardiac complication within risk classes A, B, C, and D were 1%, 3%, 9%, and 4%, respectively (p < 0.01).
Using a large multi-institutional dataset, the ThRCRI can differentiate patients at higher risk for cardiac complication following lung resection (classes C and D) and can be a useful preoperative instrument. The ThRCRI may allow for identifying patients who would benefit from additional cardiac evaluation.
胸段修订心脏指数（ThRCRI）是一种可区分可能进行肺切除术的患者（A类或B类）与应接受额外心脏评估的患者（C类或D类）的工具。本研究旨在利用一个大型多机构数据集描述ThRCRI根据主要心脏并发症发生率对患者进行分层的能力。
在美国外科医师学会国家外科质量改进计划数据集中识别2005年至2012年期间接受肺叶切除术或全肺切除术的患者。根据术前危险因素的综合评分将患者分为4个风险类别：缺血性心脏病、脑血管疾病、肾脏合并症和全肺切除术。主要结局是4个风险类别中每一类围手术期主要心脏并发症的发生率。
在识别出的4625例患者中，大多数因恶性疾病接受手术（78%），且采用开放手术（70%）。在ThRCRI危险因素中，9%的患者有缺血性心脏病，7%有脑血管疾病，2%有肾脏合并症，6%接受了全肺切除术。所有患者心脏并发症的发生率为2%。A、B、C和D风险类别中心脏并发症的发生率分别为1%、3%、9%和4%（p<0.01）。
利用大型多机构数据集，ThRCRI可以区分肺切除术后心脏并发症风险较高的患者（C类和D类），并且可以成为一种有用的术前工具。ThRCRI可能有助于识别那些将从额外心脏评估中获益的患者。
