title: Does the revised cardiac risk index predict cardiac complications following elective lung resection?
abstract: 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.
authors.forename: Robin
authors.initials: R
authors.lastname: Wotton
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
authors.forename: Amy
authors.initials: A
authors.lastname: Kerr
authors.forename: Ehab
authors.initials: E
authors.lastname: Bishay
authors.forename: Maninder
authors.initials: M
authors.lastname: Kalkat
authors.forename: Pala
authors.initials: P
authors.lastname: Rajesh
authors.forename: Richard
authors.initials: R
authors.lastname: Steyn
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK. b.naidu@bham.ac.uk.
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdelaziz
authors.forename: Khalid
authors.initials: K
authors.lastname: Hussain
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors