Revised Cardiac Risk Index: Difference between revisions
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The component of the Index are: | The component of the Index are: | ||
* high-risk surgery (intraperitoneal, intrathoracic, or vascular surgery above the inguinal ligaments). See [ | * high-risk surgery (intraperitoneal, intrathoracic, or vascular surgery above the inguinal ligaments). See [[Preoperative care#Cardiac risk by type of surgery|prognosis by surgery type]]. | ||
* history of ischemic heart disease | * 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" | ** 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" | ||
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The RCRI has been validated among patients | ==Independent validations== | ||
The RCRI has been validated among patients undergoing surgery for [[peripheral arterial disease]].<ref name="pmid19376487">{{cite journal |author=Hoeks SE, op Reimer WJ, van Gestel YR, ''et al.'' |title=Preoperative cardiac risk index predicts long-term mortality and health status |journal=Am. J. Med. |volume=122 |issue=6 |pages=559–65 |year=2009 |month=June |pmid=19376487 |doi=10.1016/j.amjmed.2008.10.041 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(09)00101-6 |issn=}}</ref> | |||
The RCRI has been validated among patients although exploratory analyses suggested that adding age and surgical details would improve the model.<ref name="pmid16194645">{{cite journal |author=Boersma E, Kertai MD, Schouten O, ''et al.'' |title=Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index |journal=Am. J. Med. |volume=118 |issue=10 |pages=1134–41 |year=2005 |month=October |pmid=16194645 |doi=10.1016/j.amjmed.2005.01.064 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(05)00170-1 |issn=}}</ref> In this study, surgery risk was assigned using an adaptation of the [[American College of Cardiology]] and [[American Heart Association]] 2002<ref name="pmid11889023">Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). [http://circ.ahajournals.org/cgi/content/full/105/10/1257 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 [http://circ.ahajournals.org/cgi/content/full/105/10/1257/TBL3 Table 3 for surgical risk]</ref> 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) | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 08:19, 28 August 2009
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] The original index was published in 1977.[2]
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)[3] | |
| ≥ 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.[4]
The RCRI has been validated among patients although exploratory analyses suggested that adding age and surgical details would improve the model.[3] In this study, surgery risk was assigned using an adaptation of the American College of Cardiology and American Heart Association 2002[5] 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)
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]
- ↑ 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]
- ↑ 3.0 3.1 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