Interpretation
| Result | Meaning |
|---|---|
| 0 (class I) | 0.4% (CCS 3.9%) |
| 1 (class II) | 0.9% (6.0%) |
| 2 (class III) | 6.6% (10.1%) |
| ≥ 3 (class IV) | 11% (15%) |
Formula
One point each: high-risk surgery · ischemic heart disease · congestive heart failure · cerebrovascular disease · insulin-treated diabetes · preoperative creatinine > 2.0 mg/dL (177 µmol/L)
Clinical pearls
- The 2017 CCS guideline recommends preoperative BNP/NT-proBNP for patients ≥65, aged 45–64 with significant cardiovascular disease, or RCRI ≥1.
- Original event rates (Lee 1999) underestimate contemporary risk when troponin surveillance is used; CCS pooled rates are higher.
Examples
rcri for aortic surgery in a patient with prior mi and insulin diabetes, creatinine 1.3revised cardiac risk index laparotomy, chf, cr 2.4lee index knee replacement no cardiac history creatinine 80 umol/L
FAQ
What are the six RCRI criteria?
High-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin-treated diabetes and creatinine above 2.0 mg/dL.
What RCRI score is high risk?
Two or more points indicates elevated risk (6.6% or higher major cardiac complications in the original study).
Evidence
- Lee TH et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100:1043–9.
- Duceppe E et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol 2017;33:17–32.