According to the Lee Revised Cardiac Risk Index (RCRI), which combination of factors in a patient scheduled for major non-cardiac surgery places him at HIGHEST cardiac risk (RCRI score 3)?

• A Age >70, male sex, hypertension
• B Obesity, smoking, peripheral vascular disease
• C ASA III status, prior MI >6 months, age >65
• D Ischaemic heart disease, insulin-dependent diabetes, creatinine >2 mg/dL ✓

Explanation

The Revised Cardiac Risk Index (Lee, 1999) has 6 validated predictors of major adverse cardiac events (MACE) perioperatively: (1) high-risk surgery (suprainguinal vascular, intrathoracic, intraperitoneal); (2) ischaemic heart disease; (3) congestive heart failure; (4) cerebrovascular disease; (5) insulin-dependent diabetes mellitus; (6) preoperative creatinine >2 mg/dL. Each scores 1 point. Score 0 = 0.4% risk; score 1 = 1%; score 2 = 2.4%; score ≥3 = 5.4% risk of MACE. Age, obesity, and hypertension are NOT components of the RCRI.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.