From the Guidelines
The Revised Cardiac Risk Index (RCRI) is the best risk stratification tool for preoperative evaluation, as it is a simple, validated, and accepted tool to assess perioperative risk of major cardiac complications. This index has 6 predictors of risk for major cardiac complications, including the type of surgery, history of ischemic heart disease, history of heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative creatinine ≥ 2 mg/dL 1. The RCRI is widely used and has been shown to be effective in predicting cardiac risk in non-cardiac surgery patients.
Some of the key benefits of the RCRI include its simplicity and ease of use, as well as its ability to identify patients at high risk of cardiac complications. The RCRI has been validated in several studies and has been shown to be a reliable tool for predicting cardiac risk 1. While other risk stratification tools, such as the American Society of Anesthesiologists (ASA) Physical Status Classification System, may also be useful, the RCRI is specifically designed to assess cardiac risk and is therefore the most appropriate tool for preoperative evaluation.
In terms of implementation, healthcare providers should evaluate the patient's medical history, current medications, physical examination findings, and laboratory results to assign the appropriate RCRI score. This score can then be used to guide anesthetic management, determine the need for additional testing, and anticipate potential complications. Overall, the RCRI is a valuable tool for preoperative evaluation and can help healthcare providers make informed decisions about patient care.
The use of the RCRI can be supplemented with other tools, such as the NSQIP MICA risk-prediction rule, which can provide additional information about cardiac risk 1. However, the RCRI remains the most widely used and accepted tool for preoperative cardiac risk assessment. By using the RCRI, healthcare providers can help reduce the risk of cardiac complications and improve patient outcomes.
Key points to consider when using the RCRI include:
- The RCRI is a simple and easy-to-use tool for assessing cardiac risk
- The RCRI has 6 predictors of risk for major cardiac complications
- The RCRI is widely used and has been validated in several studies
- The RCRI can be supplemented with other tools, such as the NSQIP MICA risk-prediction rule
- The RCRI can help healthcare providers make informed decisions about patient care and reduce the risk of cardiac complications.
From the Research
Risk Stratification Tools
The Revised Cardiac Risk Index (RCRI) is a widely used tool for preoperative risk stratification in non-cardiac surgeries 2, 3, 4, 5. It predicts major cardiac outcomes from six independent clinical determinants: history of ischemic heart disease, history of cardiovascular disease, heart failure, insulin-dependent diabetes mellitus, and chronic renal failure.
Comparison of Risk Stratification Tools
Other risk scores include the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION), the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), and the Preoperative Score to Predict Postoperative Mortality (POSPOM) 3. The National Surgical Quality Improvement Program database (NSQIP) has also developed a new index to predict perioperative myocardial infarction or cardiac arrest (MICA) 3.
Predictive Accuracy of RCRI
Studies have shown that the RCRI has good predictive accuracy, with event rates increasing as the RCRI class increases 2, 5. However, its accuracy is suboptimal in many clinical settings, and it may need to be updated to improve its predictive accuracy 2, 3. The addition of biomarkers such as N-terminal brain natriuretic peptide (NT pro-BNP) and high-sensitivity troponin I (hs TnI) to the RCRI may improve its predictive power 4.
Clinical Application of RCRI
The RCRI has been shown to be a useful tool in preoperative risk stratification, and its use is recommended by the European guidelines for risk stratification in non-cardiac surgery 3. It can be used to identify patients at low risk for perioperative adverse cardiovascular events, and its predictive accuracy can be improved by combining it with other clinical scores and biomarkers 4, 6.
Key Factors in RCRI
The key factors in the RCRI include:
- History of ischemic heart disease
- History of cardiovascular disease
- Heart failure
- Insulin-dependent diabetes mellitus
- Chronic renal failure
- High-risk surgery These factors can be used to predict the risk of major cardiac complications in patients undergoing non-cardiac surgery 2, 5.
Limitations of RCRI
The RCRI has some limitations, including its suboptimal accuracy in many clinical settings and the need for further updates to improve its predictive accuracy 2, 3. Additionally, the RCRI may not be suitable for all patient populations, and other risk scores may be more appropriate in certain clinical settings 3.