Anaesthesia · Preoperative Assessment (PAC) and Special Conditions

Revised Cardiac Risk Index (RCRI/Lee Index) includes which 6 factors for estimating perioperative major cardiac events?

  • A Age >70, male sex, hypertension, smoking, BMI >30, prior MI
  • B ECG abnormalities, low ejection fraction, poor exercise tolerance, NYHA class, valvular disease, age >65
  • C High-risk surgery, ischaemic heart disease, congestive heart failure, cerebrovascular disease, diabetes on insulin, creatinine >2.0 mg/dL
  • D Prior cardiac arrest, elevated troponin, BNP >300, renal failure, anaemia, obesity
Correct answer: C. High-risk surgery, ischaemic heart disease, congestive heart failure, cerebrovascular disease, diabetes on insulin, creatinine >2.0 mg/dL

Explanation

The Revised Cardiac Risk Index (Lee, 1999) identifies 6 independent predictors of major perioperative cardiac events: (1) high-risk surgery (intrathoracic, intraperitoneal, supringuinal vascular); (2) history of ischaemic heart disease; (3) history of congestive heart failure; (4) history of cerebrovascular disease (stroke/TIA); (5) insulin-dependent diabetes mellitus; (6) preoperative creatinine >2.0 mg/dL. Each factor scores 1 point: score 0 = <1% risk; 1 = 1%; 2 = ~2.4%; ≥3 = >5% risk. It is the most widely validated perioperative cardiac risk score and forms the foundation of AHA/ESC cardiac pre-assessment guidelines.

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

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