Cardiac complications lead to postoperative disability and death.
- Howell SJ
- Brown OI
- Beattie WS.
Aetiology of perioperative myocardial injury: a scientific conundrum with profound clinical implications.
Br J Anaesth. 2020; 125: 642-646
2Preoperative 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.
- Beattie WS.
The emergence of a postoperative myocardial injury epidemic: true or false.
Can J Anaesth. 2021; 68: 1109-1119
3The Revised Cardiac Risk Index
- Biccard B.
Proposed research plan for the derivation of a new cardiac risk index.
Anesth Analg. 2015; 120: 543-553
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).
- Lee TH
- Marcantonio ER
- Mangione CM
- et al.
Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.
Circulation. 1999; 100: 1043-1049
5Taken together, these results show the RCRI to be accurate, easy to use, and generalisable, thus making it an almost ideal tool for clinical use.
- Ford MK
- Beattie WS
- Wijeysundera DN.
Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.
Ann Intern Med. 2010; 152: 26-35
Table 1The revised cardiac risk index
|High-risk surgery||a) Intraperitoneal
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
|Preoperative treatment with insulin|
|Chronic renal failure||a) Preoperative creatinine > 177 µmol/L|
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- Aetiology of perioperative myocardial injury: a scientific conundrum with profound clinical implications.Br J Anaesth. 2020; 125: 642-646
- The emergence of a postoperative myocardial injury epidemic: true or false.Can J Anaesth. 2021; 68: 1109-1119
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Published online: June 20, 2021
Accepted: June 11, 2021
Received: May 30, 2021
See article by Roshanov et al., pages 1215–1224 of this issue.
See page 1161 for disclosure information.
© 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.