Validation of a modified scoring system for cardiovascular risk associated with major lung resection
Validation of a modified scoring system for cardiovascular risk associated with major lung resection
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DOI：
10.1093/ejcts/ezr081
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发表时间：
2012-03-01
影响因子：
3.4
通讯作者：
Vigneswaran, Wickii T.
中科院分区：
文献类型：
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作者：
Ferguson, Mark K.;Celauro, Amy D.;Vigneswaran, Wickii T.
众所周知的修订心脏风险指数（RCRI）最近已根据胸外科手术患者（ThRCRI）的特定因素和结局进行了修改。我们探讨了这种改良的评分系统在预测肺大切除术后心血管发病率方面的准确性，并分析了1980-2009年接受肺大切除术患者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、肺水肿和心源性死亡。共有1255名患者（平均年龄61.8岁; 649名男性）因癌症（1037; 83%）或其他问题接受了肺叶切除术或双叶切除术（1070; 85%）或全肺切除术（185; 15%）。30例患者（2.4%）发生严重心血管并发症，发生率与已发表的衍生组（3.3%）相似。无和有严重CV并发症患者的ThRCRI中位数评分分别为0和1.5（P < 0.001）。评分类别增加了心血管并发症的风险（0：0.9%; 1-1.5：4.5%; >= 2：12.8%; P < 0.001）。Hosmer-Lemeshow检验显示预期结果与观察结果之间无显著差异（P = 0.11）。已发表的推导组和当前验证组的严重术后心血管并发症发生率相似。在验证组中，ThRCRI评分成功地将肺切除术后心血管事件的风险分层。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。需要进一步评估该评分系统的效用。
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.