Using the Revised Cardiac Risk Index (RCRI/Lee Index), which set of preoperative risk factors gives a score of 3 with approximately 10% risk of major adverse cardiac events (MACE)?

• A Ischaemic heart disease + diabetes on insulin + intraperitoneal surgery ✓
• B Hypertension + elevated creatinine + age >65 years
• C Prior CVA + congestive heart failure + beta-blocker use
• D Peripheral vascular disease + obesity + hyperlipidaemia

Explanation

The Revised Cardiac Risk Index (Lee 1999) has 6 independent predictors: (1) high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular), (2) ischaemic heart disease, (3) heart failure, (4) cerebrovascular disease (CVA/TIA), (5) insulin-dependent diabetes mellitus, (6) preoperative creatinine >2 mg/dL. Each factor scores 1 point. Score 0 = 0.4%, 1 = 1%, 2 = 2.4–7%, 3+ = 5–11% MACE risk. Option A: intraperitoneal surgery (1) + IHD (1) + insulin-dependent DM (1) = 3 factors. Hypertension, age, obesity, beta-blocker use, and lipid levels are NOT RCRI predictors.

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

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