Cardiac complications lead to postoperative disability and death.
1
,2
Preoperative cardiac risk stratification provides an opportunity to implement risk
reduction, optimise the use of scarce resources, assess the quality of care, and facilitate
clinical research.
3
The Revised Cardiac Risk Index
4
(RCRI) has gained wide acceptance for noncardiac surgery risk stratification. The
original publication found that the 6 factors, presented in Table 1, discriminated well across mixed noncardiac surgical procedures (area under the receiver
operating characteristic curve [AUC] 0.79). A 2010 systematic review identified 24
studies that included 800,000 patients and found that the RCRI performed as well as
in the original analysis. (pooled AUC 0.75, 95% confidence interval [CI] 0.79-0.72).
5
Taken together, these results show the RCRI to be accurate, easy to use, and generalisable,
thus making it an almost ideal tool for clinical use.
Table 1The revised cardiac risk index
| Risk factor | Definition |
|---|---|
| High-risk surgery | a) Intraperitoneal b) Intrathoracic c) Supra-inguinal vascular |
| History of ischemic heart disease | a) History of myocardial infarction b) History of positive exercise test c) Current chest pain due to myocardial ischemia d) Use of nitrate therapy e) Electrocardiogram with pathologic Q waves |
| History of congestive heart failure | a) Pulmonary edema, b) Bilateral rales or S3 gallop c) Paroxysmal nocturnal dyspnea d) X-ray showing pulmonary vascular redistribution |
| History of cerebrovascular disease | a) Prior transient ischemic attack b) Stroke |
| Preoperative treatment with insulin | |
| Chronic renal failure | a) Preoperative creatinine > 177 µmol/L |
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Article info
Publication history
Published online: June 20, 2021
Accepted:
June 11,
2021
Received:
May 30,
2021
Footnotes
See article by Roshanov et al., pages 1215–1224 of this issue.
See page 1161 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION StudyCanadian Journal of CardiologyVol. 37Issue 8
- PreviewThe Revised Cardiac Risk Index (RCRI) is widely used to estimate risk of cardiac complications after noncardiac surgery; its estimates do not capture myocardial injury after noncardiac surgery (MINS). We evaluated the incidence of cardiac complications including MINS across RCRI risk classes and the RCRI's ability to discriminate, before surgery, between patients who will experience these complications and those who will not.
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