The Revised Cardiac Risk Index performs poorly in patients undergoing major vascular surgery: a prospective observational study.
The preoperative assessment of the likelihood of a postoperative cardiac event is complex. The Revised Cardiac Risk Index (RCRI) is a commonly used scoring system for the stratification of cardiac risk of patients undergoing major non-cardiac surgery. The RCRI scores patients according to six clinical categories: high-risk surgery (thoracic, abdominal and supra-inguinal vascular surgery); history of ischaemic heart disease (IHD); history of congestive heart failure; cerebrovascular disease; insulin-dependent diabetes; and renal failure. Since the publication of the original article in 1999, the RCRI has become a widely used stratification tool for cardiac risk. A recent meta-analysis has examined the predictive value of the RCRI in these studies. It concluded that the RCRI performed moderately well at discriminating between low and high perioperative risk. However, the authors felt that it performed poorly in vascular cohorts, and that the studies included were of variable quality. This report highlights the need for further studies evaluating the RCRI.