Validating the Thoracic Revised Cardiac Risk Index Following Lung Resection

The Thoracic Revised Cardiac Index (ThRCRI) is a tool that differentiates patients who may proceed to lung resection (classes A or B) from those who should receive additional cardiac evaluation (classes C or D). This study aims to describe the ability of the ThRCRI to stratify patients based on major cardiac complication rates using a large multi-institutional dataset.

Patients undergoing lobectomy or pneumonectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2012. Patients were grouped into 4 risk classes based on a summary score of preoperative risk factors: ischemic heart disease, cerebrovascular disease, renal comorbidity, and pneumonectomy. The primary outcome was the incidence of perioperative major cardiac complication in each of the 4 risk classes.

Of the 4,625 patients identified, the majority underwent surgery for malignant disease (78%) and had an open procedure (70%). Among ThRCRI risk factors, 9% of patients had ischemic heart disease, 7% had cerebrovascular disease, 2% had renal comorbidity, and 6% underwent pneumonectomy. Incidence of cardiac complication in all patients was 2%. Incidence of cardiac complication within risk classes A, B, C, and D were 1%, 3%, 9%, and 4%, respectively (p < 0.01).

Using a large multi-institutional dataset, the ThRCRI can differentiate patients at higher risk for cardiac complication following lung resection (classes C and D) and can be a useful preoperative instrument. The ThRCRI may allow for identifying patients who would benefit from additional cardiac evaluation.