From the Guidelines
Aub2 versus RCRI is not a relevant comparison in the context of valvular heart disease management, as Aub2 is not mentioned in the provided evidence, and RCRI is a risk stratification tool for predicting cardiac complications in non-cardiac surgery. The provided evidence focuses on the management of patients with valvular heart disease, specifically aortic stenosis and aortic regurgitation, and discusses various factors that influence treatment decisions, such as symptoms, LV systolic function, and disease severity 1.
- The 2020 ACC/AHA guideline for the management of patients with valvular heart disease emphasizes the importance of symptoms, LV systolic function, and disease severity in determining treatment outcomes 1.
- In patients with severe aortic stenosis, AVR is recommended for those with symptoms, as it improves survival, symptoms, and LV systolic function 1.
- The guideline also discusses the role of TAVI in patients with severe aortic stenosis, including those with low-flow, low-gradient severe AS with preserved LVEF 1. In contrast, the RCRI is a tool used to predict cardiac complications in patients undergoing non-cardiac surgery, and it assesses six factors, including high-risk surgery, history of ischemic heart disease, and preoperative serum creatinine > 2.0 mg/dL 1.
- The RCRI assigns one point for each factor present, with higher scores indicating greater risk of cardiac complications. Given the different contexts and purposes of these tools, a direct comparison between Aub2 and RCRI is not relevant or meaningful in the context of valvular heart disease management. The most important consideration in managing patients with valvular heart disease is to prioritize treatment decisions based on individual patient factors, such as symptoms, LV systolic function, and disease severity, rather than relying on a single risk stratification tool like RCRI.
From the Research
Comparison of Aub2 and RCRI
- The Revised Cardiac Risk Index (RCRI) is a widely used tool for peri-operative risk assessment before elective major non-cardiac surgeries 2.
- RCRI scoring system categorizes patients into 4 classes depending on 0,1,2, and ≥3 risk predictors, including high-risk surgery, history of ischemic heart disease, diabetes on insulin, history of stroke, history of congestive heart failure, and serum creatinine of >2 mg% 2.
- Studies have shown that RCRI is a useful tool in pre-operative risk stratification, with event rates increasing as the RCRI class increases 2, 3.
- However, there is limited information available on Aub2, and no direct comparison between Aub2 and RCRI can be made based on the provided evidence.
- The available studies focus on the use of RCRI in pre-operative risk assessment and its prognostic accuracy for major cardiac complications 2, 3.
Perioperative Risk Assessment
- Perioperative cardiovascular complications are important causes of morbidity and mortality associated with non-cardiac surgery, particularly in patients with coronary artery disease (CAD) 4.
- Preoperative cardiac risk assessment can facilitate the identification of vulnerable patients and implementation of adequate preventive measures 4, 5.
- A stepwise approach to preoperative cardiovascular risk assessment is recommended, including evaluation of clinical risk factors, functional status, and the estimated stress of the planned surgical procedure 5.
- Validated scores, such as RCRI or National Surgical Quality Improvement Program (NSQIP), can be used to estimate perioperative risk for major cardiac adverse events 5.
Limitations
- There is no direct comparison between Aub2 and RCRI available in the provided evidence.
- The available studies focus on the use of RCRI in pre-operative risk assessment, and more research is needed to fully understand its relationship with Aub2.