Revised Cardiac Risk Index
The Revised Cardiac Risk Index is a tool used to estimate a patient's risk of perioperative cardiac complications.
Description
The RCRI and similar clinical prediction tools are derived by looking for an association between preoperative variables and the risk for cardiac complications in a cohort of surgical patients. Variables that have independent predictive value in a logistic regression analysis are incorporated into the risk index. Ideally, the accuracy and validity of the risk index is then tested in a separate cohort. In 1977 Goldman, et al., developed the first cardiac risk index, which included nine variables associated with an increased risk of perioperative cardiac complications. This became known as the Original Cardiac Risk Index. In 1999, Lee et al. published a cardiac risk index derived from 2893 patients and validated in 1422 patients aged ≥ 50 undergoing major noncardiac surgery, which became known as the Revised Cardiac Risk Index. Lee identified six independent variables that predicted an increased risk for cardiac complications. A patient's risk for perioperative cardiac complications increased with number of variables that were present.| Revised Cardiac Risk Index |
| 1. History of ischemic heart disease |
| 2. History of congestive heart failure |
| 3. History of cerebrovascular disease |
| 4. History of diabetes requiring preoperative insulin use |
| 5. Chronic kidney disease |
| 6. Undergoing suprainguinal vascular, intraperitoneal, or intrathoracic surgery |
| Risk for cardiac death, nonfatal myocardial infarction, and nonfatal cardiac arrest: 0 predictors = 3.9%, 1 predictor = 6.0%, 2 predictors = 10.1%, ≥3 predictors = 15% |
Compared with the Original Cardiac Risk Index, the RCRI was easier to use and more accurate. The RCRI was used widely in clinical practice, research, and was incorporated in a modified form into the 2007 preoperative cardiac risk evaluation guideline from the American Heart Association and American College of Cardiology. The ACC/AHA guidelines use the 5 clinical RCRI criteria in their screening algorithm. The surgery-specific risk is included separately in the algorithm. Criterion #4, diabetes with insulin use was also changed to any diagnosis of diabetes in the ACC/AHA algorithm.
2014 ACC/AHA Perioperative Guidelines stated that two newer tools have been created by the American College of Surgeons, which prospectively collected data on operations performed in more than 252 participating hospitals in the United States. Data on more than 1 million operations have been used to create these risk calculators. This tool includes adjusted ORs for different surgical sites, with inguinal hernia as the reference group. Target complications were defined as cardiac arrest or MI.