Clinical Decision-Making
Revised Cardiac Risk Index: Perioperative Risk Assessment Guide
The Revised Cardiac Risk Index (RCRI) stratifies cardiac risk before noncardiac surgery using 6 clinical variables. RCRI 0 = <1% MACE risk; RCRI ≥3 = ~5% or higher. Adding perioperative high-sensitivity troponin surveillance provides incremental prognostic benefit beyond RCRI alone.
TL;DR: The RCRI stratifies cardiac risk before noncardiac surgery using 6 clinical variables. RCRI 0 = <1% MACE risk; RCRI ≥3 = ~5% or higher. Perioperative cardiovascular complications affect 3% of all hospitalizations for noncardiac surgery in the US.
RCRI Calculation
Each present = 1 point: High-risk surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin therapy for diabetes, preoperative serum creatinine >2 mg/dL.
Score Interpretation
| RCRI Score | MACE Risk | Approach |
|---|---|---|
| 0 | <1% | Proceed to surgery |
| 1 | ~1% | Proceed; optimize medical therapy |
| 2 | ~2.5% | Consider functional capacity; stress test if poor |
| ≥3 | ~5%+ | Cardiology consultation; stress testing likely |
Evidence
Smilowitz NR, Berger JS (2020) provided the landmark JAMA review of perioperative cardiovascular risk assessment. JAMA. 2020;324(3):279–290. PMID: 32692391.
Chew MS et al. (2022) showed perioperative troponin surveillance adds incremental prognostic value beyond RCRI. Br J Anaesth. 2022;128(1):26–36. PMID: 34857357.
References
- Smilowitz NR, Berger JS. JAMA. 2020;324(3):279–290. PMID: 32692391.
- Chew MS, et al. Br J Anaesth. 2022;128(1):26–36. PMID: 34857357.
- Lee TH, et al. Circulation. 1999;100(10):1043–1049. PMID: 10477528.
- Fleisher LA, et al. J Am Coll Cardiol. 2014;64(22):e77–e137. PMID: 25091544.