Revised Cardiac Risk Index
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The Revised Cardiac Risk Index (RCRI) is a clinical prediction rule for use during preoperative care for prediction major cardiac complications of noncardiac surgery.[1][2] The original index was published in 1977.[3]
The component of the Index are:
- high-risk surgery (intraperitoneal, intrathoracic, or vascular surgery above the inguinal ligaments). See prognosis by surgery type.
- history of ischemic heart disease
- Includes "history of myocardial infarction, history of a positive exercise test, current complaint of chest pain considered to be secondary to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves"
- Excludes: "patients with prior coronary revascularization procedures were categorized as having ischemic heart disease only if they had any of the other criteria"
- history of congestive heart failure
- history of cerebrovascular disease
- preoperative treatment with insulin
- preoperative serum creatinine >2.0 mg/dL
| Number of risk factors | Mortality | |
|---|---|---|
| Major cardiac complications (Original study)[1] |
Cardiovascular death (Independent validation)[4] | |
| ≥ 3 | 11% | 3.6% |
| 2 | 7% | 1.7% |
| 1 | 0.9% | 0.7% |
| 0 | 0.4% | 0.3% |
Independent validations
The RCRI has been validated among patients undergoing surgery for peripheral arterial disease.[5]
The RCRI has been validated among patients although exploratory analyses suggested that adding age and surgical details would improve the model.[4] In this study, surgery risk was assigned using an adaptation of the American College of Cardiology and American Heart Association 2002[6] guidelines:
- high risk (aortic)
- intermediate-high risk (abdominal; ear, nose, throat; neurologic; pulmonary; renal transplant; vascular, excluding aortic and carotid)
- low-intermediate risk (orthopedic, urologic)
- low risk (breast, carotid, dental, endocrine, eye, gynecology, reconstructive)
Alternatives
One option is the Surgical Mortality Probability Model(S-MPM)[7]; however, the authors of the RCRI have discussed the differences in the two approaches.[8]
References
- ↑ 1.0 1.1 Lee TH, Marcantonio ER, Mangione CM, et al (1999). "Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery". Circulation 100 (10): 1043–9. PMID 10477528. [e]
- ↑ Ford MK, Beattie WS, Wijeysundera DN (2010). "Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.". Ann Intern Med 152 (1): 26-35. DOI:10.1059/0003-4819-152-1-201001050-00007. PMID 20048269. Research Blogging.
- ↑ Goldman L, Caldera DL, Nussbaum SR, et al (October 1977). "Multifactorial index of cardiac risk in noncardiac surgical procedures". N. Engl. J. Med. 297 (16): 845–50. PMID 904659. [e]
- ↑ 4.0 4.1 Boersma E, Kertai MD, Schouten O, et al. (October 2005). "Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index". Am. J. Med. 118 (10): 1134–41. DOI:10.1016/j.amjmed.2005.01.064. PMID 16194645. Research Blogging.
- ↑ Hoeks SE, op Reimer WJ, van Gestel YR, et al. (June 2009). "Preoperative cardiac risk index predicts long-term mortality and health status". Am. J. Med. 122 (6): 559–65. DOI:10.1016/j.amjmed.2008.10.041. PMID 19376487. Research Blogging.
- ↑ Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery---executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation. 2002 Mar 12;105(10):1257-67. Erratum in: Circulation. 2006 Jun 6;113(22):e846. PMID 11889023 (See Table 3 for surgical risk
- ↑ Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F et al. (2012). "The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery.". Ann Surg 255 (4): 696-702. DOI:10.1097/SLA.0b013e31824b45af. PMID 22418007. Research Blogging.
- ↑ Lee TH, Goldman L (2012). "Letter by Lee and Goldman regarding article, "Development and validation of a risk calculator for prediction of cardiac risk after surgery".". Circulation 125 (7): e385; author reply e386. DOI:10.1161/CIRCULATIONAHA.111.068999. PMID 22354985. Research Blogging.