Key result
The Revised Cardiac Risk Index (RCRI) and Thoracic RCRI scores demonstrated poor discriminative ability for predicting postoperative cardiac complications following elective lung resection, with AUCs of 0.59 and 0.57 respectively.
Why the study?
Do the RCRI and ThRCRI scores accurately predict postoperative cardiac complications in patients undergoing elective lung resection?
Observational (n=703)
No
Do the RCRI and ThRCRI scores accurately predict postoperative cardiac complications in patients undergoing elective lung resection?
Effect estimate: AUC 0.59 (95% CI 0.51-0.67)
The RCRI and ThRCRI scores demonstrated poor discriminative ability for predicting postoperative cardiac complications in patients undergoing elective lung resection, suggesting that guideline recommendations for cardiology referral based on these scores may not be clinically beneficial.
RCRI and ThRCRI may lack predictive utility for cardiac complications after lung resection; leaves open need for better risk models in this population.
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.
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Wotton et al. (2013) conducted an observational in Elective lung resection surgery (n=703). Revised Cardiac Risk Index (RCRI) and Thoracic RCRI (ThRCRI) was evaluated on Postoperative major cardiac complications and supraventricular arrhythmias (AUC 0.59, 95% CI 0.51-0.67). The Revised Cardiac Risk Index (RCRI) and Thoracic RCRI scores demonstrated poor discriminative ability for predicting postoperative cardiac complications following elective lung resection, with AUCs of 0.59 and 0.57 respectively.
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