Recalibration of the Revised Cardiac Risk Index in Lung Resection Candidates
Recalibration of the Revised Cardiac Risk Index in Lung Resection Candidates
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DOI：
10.1016/j.athoracsur.2010.03.042
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发表时间：
2010-07-01
影响因子：
4.6
通讯作者：
Sabbatini, Armando
中科院分区：
文献类型：
--
作者：
Brunelli, Alessandro;Varela, Gonzalo;Sabbatini, Armando
背景修订的心脏风险指数（RCRI）已被提议作为肺切除术前心脏风险分层的工具。然而，RCRI最初是从包括一小群胸外科患者的通用手术人群中开发的。本研究的目的是重新校准肺切除术候选者的RCRI，为心脏病风险分层提供更具体的工具。分析了2000年至2008年间在两个中心接受肺叶切除术（1,426例）或全肺切除术（270例）的1696例患者。逐步逻辑回归和自助分析被用来重新校准的六个变量组成的RCRI。结果变量为主要心脏并发症的发生率（心脏骤停、完全性心脏传导阻滞、急性心肌梗死、肺水肿或住院期间心源性死亡）。只有那些在超过50%的自助样本中概率小于0.1的变量被保留在最终模型中，并根据其回归估计按比例加权。主要心脏病发病率为3.3%（57例患者）。RCRI中的6个变量中有4个与主要心脏并发症可靠相关：脑血管疾病（1.5分）、心脏缺血（1.5分）、肾脏疾病（1分）和肺切除术（1.5分）。根据重新校准的RCRI将患者分为四类，预测心脏病发病风险增加（p < 0.0001）。与传统的RCRI相比，重新校准后的评分具有更高的区分度（c指数，0.72vs0.62; p = 0.004）。重新校准的RCRI可以可靠地用作心脏病风险分层期间的一线筛选工具，用于从无需任何进一步心脏检查即可进行肺部评估的患者中选择需要进一步心脏检查的患者。
Background. The revised cardiac risk index (RCRI) has been proposed as a tool for cardiac risk stratification before lung resection. However, the RCRI was originally developed from a generic surgical population including a small group of thoracic patients. The objective of this study was to recalibrate the RCRI in candidates for major lung resections to provide a more specific instrument for cardiac risk stratification.Methods. One thousand six hundred ninety-six patients who underwent lobectomy (1,426) or pneumonectomy (270) in two centers between the years of 2000 and 2008 were analyzed. Stepwise logistic regression and bootstrap analyses were used to recalibrate the six variables comprising the RCRI. The outcome variable was occurrence of major cardiac complications (cardiac arrest, complete heart block, acute myocardial infarction, pulmonary edema, or cardiac death during admission). Only those variables with a probability of less than 0.1 in more than 50% of bootstrap samples were retained in the final model and proportionally weighted according to their regression estimates.Results. The incidence of major cardiac morbidity was 3.3% (57 patients). Four of the six variables present in the RCRI were reliably associated with major cardiac complications: cerebrovascular disease (1.5 points), cardiac ischemia (1.5 points), renal disease (1 point), and pneumonectomy (1.5 points). Patients were grouped into four classes according to their recalibrated RCRI, predicting an incremental risk of cardiac morbidity (p < 0.0001). Compared with the traditional RCRI, the recalibrated score had a higher discrimination (c indexes, 0.72 versus 0.62; p = 0.004).Conclusions. The recalibrated RCRI can be reliably used as a first-line screening instrument during cardiologic risk stratification for selecting those patients needing further cardiologic testing from those who can proceed with pulmonary evaluation without any further cardiac tests.