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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Revised Cardiac Risk Index (RCRI)
Introduction
The Revised Cardiac Risk Index (RCRI) is a widely used tool to assess the risk of major cardiac complications in patients undergoing non-cardiac surgery. It helps estimate the probability of adverse cardiovascular events, such as heart attacks or cardiac arrest, based on specific preoperative risk factors.
Risk Factors in RCRI
RCRI includes six independent predictors of major cardiac events: 1. History of ischemic heart disease (e.g., previous heart attack or angina) 2. History of congestive heart failure 3. History of cerebrovascular disease (e.g., previous stroke or transient ischemic attack) 4. Diabetes mellitus requiring insulin 5. Chronic kidney disease (serum creatinine ≥2.0 mg/dL) 6. High-risk surgery (such as major vascular, intraperitoneal, or intrathoracic surgery)
Each risk factor is assigned one point. The greater the number of risk factors, the higher the predicted risk of major cardiac complications.
RCRI Score Interpretation
- 0 risk factors → Low risk (<1%)
- 1 risk factor → Low to moderate risk (~1%)
- 2 risk factors → Moderate risk (~6%)
- ≥3 risk factors → High risk (>10%)
Clinical Application
- For patients with low risk (0–1 points): Surgery can proceed with minimal additional cardiac testing.
- For moderate-risk patients (2 points): Further cardiac evaluation may be needed, especially if symptoms of heart disease are present.
- For high-risk patients (≥3 points): A detailed cardiac workup, including stress testing or cardiology consultation, is recommended before surgery.
Conclusion
The RCRI is an essential tool in preoperative risk assessment. However, additional clinical judgment, functional capacity assessment, and other risk stratification models (such as NT-proBNP testing or imaging) may be used to refine decision-making.
Source recommendations
1. 2014 AHA/ACC Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery
- https://www.ahajournals.org/doi/10.1161/cir.0000000000000106
- https://pubmed.ncbi.nlm.nih.gov/25085962/
- https://www.jacc.org/doi/10.1016/j.jacc.2024.06.013
- https://pubmed.ncbi.nlm.nih.gov/25091544/
- https://www.jacc.org/doi/10.1016/j.jacc.2014.07.945
2. 2022 ESC Guidelines on Cardiovascular Assessment and Management of Patients Undergoing Non-cardiac Surgery
- https://academic.oup.com/eurheartj/article/43/39/3826/6675076
- https://pubmed.ncbi.nlm.nih.gov/36017553/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-Guidelines-on-non-cardiac-surgery-cardiovascular-assessment-and-managem
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/01/13/18/2022-ESC-Guidelines-on-Noncardiac-Surgery-ESC-2022
- https://www.portailvasculaire.fr/sites/default/files/docs/2022_esc_evaluation_cv_pre-operatoire_chirurgie_non_cardiaque.pdf
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