Revised Cardiac Risk Index: Difference between revisions
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The '''Revised Cardiac Risk Index''' is a [[clinical prediction rule]] for use during [[preoperative care]] for prediction major cardiac complications of noncardiac surgery.<ref name="pmid10477528">{{cite journal |author=Lee TH, Marcantonio ER, Mangione CM, ''et al'' |title=Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery |journal=Circulation |volume=100 |issue=10 |pages=1043–9 |year=1999 |pmid=10477528 |doi= |issn=}}</ref> | The '''Revised Cardiac Risk Index''' (RCRI) is a [[clinical prediction rule]] for use during [[preoperative care]] for prediction major cardiac complications of noncardiac surgery.<ref name="pmid10477528">{{cite journal |author=Lee TH, Marcantonio ER, Mangione CM, ''et al'' |title=Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery |journal=Circulation |volume=100 |issue=10 |pages=1043–9 |year=1999 |pmid=10477528 |doi= |issn=|url=http://circ.ahajournals.org/cgi/content/full/100/10/1043}}</ref><ref name="pmid20048269">{{cite journal| author=Ford MK, Beattie WS, Wijeysundera DN| title=Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. | journal=Ann Intern Med | year= 2010 | volume= 152 | issue= 1 | pages= 26-35 | pmid=20048269 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20048269 | doi=10.1059/0003-4819-152-1-201001050-00007 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> The original index was published in 1977.<ref name="pmid904659">{{cite journal |author=Goldman L, Caldera DL, Nussbaum SR, ''et al'' |title=Multifactorial index of cardiac risk in noncardiac surgical procedures |journal=N. Engl. J. Med. |volume=297 |issue=16 |pages=845–50 |year=1977 |month=October |pmid=904659 |doi= |url= |issn=}}</ref> | |||
The component of the Index are: | The component of the Index are: | ||
* high-risk surgery (intraperitoneal, intrathoracic, or vascular surgery above the inguinal ligaments) | * 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" | |||
** 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 congestive heart failure | ||
* history of cerebrovascular disease | * history of cerebrovascular disease | ||
* preoperative treatment with insulin | |||
* preoperative serum creatinine >2.0 mg/dL | |||
{| class="wikitable" align="right" | |||
|+ Outcomes | |||
! rowspan="2"|Number of risk factors!! colspan="2"|Mortality | |||
* | |- | ||
* | ! Major cardiac complications<br/>(Original study)<ref name="pmid10477528">{{cite journal |author=Lee TH, Marcantonio ER, Mangione CM, ''et al'' |title=Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery |journal=Circulation |volume=100 |issue=10 |pages=1043–9 |year=1999 |pmid=10477528 |doi= |issn=|url=http://circ.ahajournals.org/cgi/content/full/100/10/1043}}</ref> !! Cardiovascular death<br/>(Independent validation)<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> | ||
|- | |||
| ≥ 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]].<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) | |||
==Alternatives== | |||
One option is the Surgical Mortality Probability Model(S-MPM)<ref name="pmid22418007">{{cite journal| author=Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F et al.| title=The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. | journal=Ann Surg | year= 2012 | volume= 255 | issue= 4 | pages= 696-702 | pmid=22418007 | doi=10.1097/SLA.0b013e31824b45af | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22418007 }} </ref>; however, the authors of the RCRI have discussed the differences in the two approaches.<ref name="pmid22354985">{{cite journal| author=Lee TH, Goldman L| title=Letter by Lee and Goldman regarding article, "Development and validation of a risk calculator for prediction of cardiac risk after surgery". | journal=Circulation | year= 2012 | volume= 125 | issue= 7 | pages= e385; author reply e386 | pmid=22354985 | doi=10.1161/CIRCULATIONAHA.111.068999 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22354985 }} </ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 00:26, 23 May 2012
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][2] The original index was published in 1977.[3]
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)[4] | |
| ≥ 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.[5]
The RCRI has been validated among patients although exploratory analyses suggested that adding age and surgical details would improve the model.[4] In this study, surgery risk was assigned using an adaptation of the American College of Cardiology and American Heart Association 2002[6] 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)
Alternatives
One option is the Surgical Mortality Probability Model(S-MPM)[7]; however, the authors of the RCRI have discussed the differences in the two approaches.[8]
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]
- ↑ Ford MK, Beattie WS, Wijeysundera DN (2010). "Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.". Ann Intern Med 152 (1): 26-35. DOI:10.1059/0003-4819-152-1-201001050-00007. PMID 20048269. Research Blogging.
- ↑ 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]
- ↑ 4.0 4.1 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
- ↑ Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F et al. (2012). "The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery.". Ann Surg 255 (4): 696-702. DOI:10.1097/SLA.0b013e31824b45af. PMID 22418007. Research Blogging.
- ↑ Lee TH, Goldman L (2012). "Letter by Lee and Goldman regarding article, "Development and validation of a risk calculator for prediction of cardiac risk after surgery".". Circulation 125 (7): e385; author reply e386. DOI:10.1161/CIRCULATIONAHA.111.068999. PMID 22354985. Research Blogging.