title: Recalibration of the revised cardiac risk index in lung resection candidates.
abstract: 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.
authors.affiliation: Ospedali Riuniti, Ancona, Italy. brunellialex@gmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Varela
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Jimenez
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pompili
authors.forename: Nuria
authors.initials: N
authors.lastname: Novoa
authors.forename: Armando
authors.initials: A
authors.lastname: Sabbatini
mesh_terms: D000368:Aged; D006305:Health Status Indicators; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment