title: Prediction of major cardiovascular events after lung resection using a modified scoring system.
abstract: BACKGROUND
  Cardiovascular complications occur in 10% to 15% of patients after major lung resection. We evaluated the utility of a revised scoring system (thoracic revised cardiac risk index; ThRCRI) in identifying patients at increased risk for major cardiovascular complications.
  
  
  METHODS
  We analyzed outcomes from the Society of Thoracic Surgeons General Thoracic Database for the period 2003 to 2011 for elective major lung resection. The ThRCRI risk score was based on weighted values for serum creatinine, coronary artery disease, cerebrovascular disease, and extent of lung resection, and was stratified into the following 4 risk categories: 0 (A); 1 to 1.5 (B); 2 to 2.5 (C); and >2.5 (D). Major cardiovascular complications included myocardial infarction, adult respiratory distress syndrome, ventricular arrhythmia requiring treatment, and all-cause death.
  
  
  RESULTS
  A total of 26,085 patients (mean age 65.4±11.4 years; 51.3% men) underwent lobectomy (21,679; 83.2%), bilobectomy (1,446; 5.5%) or pneumonectomy (1,697; 6.5%). Major cardiovascular complications occurred in 1,125 patients (4.3%). ThRCRI scores in patients without and with major cardiovascular complications were 0.6±0.9 and 1.1±1.1 (p<0.0001). Score categories yielded incremental risks of major cardiovascular complications (A: 2.9%; B: 5.8%; C: 11.9%; D: 11.1%; p<0.0001).
  
  
  CONCLUSIONS
  The ThRCRI score stratified risk moderately well for major postoperative cardiovascular events after major lung resection. Use of this scoring system might help in identifying patients who would benefit from additional preoperative evaluation and from closer perioperative monitoring.
authors.affiliation: Department of Surgery, The University of Chicago, Chicago, Illinois. Electronic address: mferguso@surgery.bsd.uchicago.edu.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: Department of Surgery, University of Colorado Denver School of Medicine, Denver, Colorado.
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
authors.affiliation: Department of Thoracic Surgery, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Varela
authors.affiliation: Division of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Brunelli
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods